Crystallization of molecular layers produced under confinement onto a surface.

It is well known that molecules confined very close to a surface arrange into molecular layers. Because solid-liquid interfaces are ubiquitous in the chemical, biological and physical sciences, it is crucial to develop methods to easily access molecular layers and exploit their distinct properties by producing molecular layered crystals. Here we report a method based on crystallization in ultra-thin puddles enabled by gas blowing, which allows to produce molecular layered crystals with thickness down to the monolayer onto a surface, making them directly accessible for characterization and further processing. By selecting four molecules with different types of polymorphs, we observed exclusive crystallization of polymorphs with Van der Waals interlayer interactions, which have not been observed with traditional confinement methods. In conclusion, the gas blowing approach unveils the opportunity to perform materials chemistry under confinement onto a surface, enabling the formation of distinct crystals with selected polymorphism.

Preoperative Management of the Adult Oncology Patient.

Anesthesiologists are experiencing first-hand the aging population, given older patients more frequently presenting for surgery, often with geriatric syndromes influencing their anesthetic management. The overall incidence and health burden of cancer morbidity and mortality are also rapidly increasing worldwide. This growth in the cancer population, along with the associated risk factors and comorbidities often accompanying a cancer diagnosis, underscores the need for anesthesiologists to become well versed in the preoperative evaluation and management of the adult patient with cancer. This article will focus on the unique challenges and opportunities for the anesthesiologist caring for the adult oncology patient presenting for surgery.

Social Determinants of Health and Preoperative Care.

Preoperative care exists as part of perioperative continuum during which anesthesiologists and surgeons optimize patients for surgery. These multispecialty efforts are important, particularly for patients with complex medical histories and those requiring major surgery. Preoperative care improves planning and determines the clinical pathway and discharge disposition. The role of nonmedical social factors in the preoperative planning is not well described in anesthesiology. Research to improve outcomes based on social factors is not well described for anesthesiologists but could be instrumental in decreasing disparities and advancing health equity in surgical patients.

Assuring the Groundwork for Success: Mentorship, Sponsorship, and Allyship for Practicing Anesthesiologists.

The challenges facing the health care industry in the post-coronavirus disease 2019 (COVID-19) pandemic world are numerous, jeopardizing wellness, and performance. Maintaining engagement and fulfillment of anesthesiologists in their work is now a critical issue in various practice settings: academic, private practice, and corporate medicine. In this article, we offer insights on how mentorship, sponsorship, and allyship are important in the advancement of the anesthesiology workforce including women and underrepresented minorities inclusive of race, gender, and disability. Mentorship, sponsorship, and allyship require a framework that intentionally addresses the programmatic structures needed to optimize the environment for increasing women, underrepresented minorities, and other diverse groups. These 3 distinct yet interrelated concepts are defined with a discussion on the value of implementation. In addition, the concept of "belonging" and its importance in enhancing the culture in anesthesiology is explored. We believe that part of the solution to wellness, recruitment and retention and improved job satisfaction of clinicians is having an environment where mentorship, sponsorship, and allyship are foundational.

Investigation of Temperature Cycling with Coupled Vessels for Efficient Deracemization of NMPA.

Chiral compounds can exist as pairs of nonsuperimposable stereoisomers (enantiomers) possessing the same physical properties but interacting differently with biological systems. This makes them interesting materials to be explored by the pharmaceutical and food industries. In this study, to obtain pure enantiomers from their conglomerates, a method that involves using a two-vessel system for deracemization of N-(2-methylbenzylidene) phenylglycine amide (NMPA) was developed. In this method, a suspension was transferred with a pulsating pumping profile between two inter-connected stirred vessels that were set at constant temperatures. As the suspension was exposed to more rapid changes in temperature, it resulted in the speeding up of the process and thus enhancing productivity in comparison to a single vessel system. The results confirmed successful deracemization of NMPA. A modified pumping profile and tubing design eliminated the issue of clogging of the transfer tubes and ensured effective suspension transfer for longer durations. Operating parameters, such as initial enantiomeric excess, vessel residence time, and suspension density were also investigated. In this method, optimization of residence time was necessary to enhance the efficiency of the process further. Results confirmed that this methodology has the potential to be more adaptable and scalable as it involved no mechanical attrition.

Sociodemographic Disparities in Postoperative Nausea and Vomiting.

BACKGROUND: Postoperative nausea and vomiting (PONV) prophylaxis is consistently considered a key indicator of anesthesia care quality. PONV may disproportionately impact disadvantaged patients. The primary objectives of this study were to examine the associations between sociodemographic factors and the incidence of PONV and clinician adherence to a PONV prophylaxis protocol. METHODS: We conducted a retrospective analysis of all patients eligible for an institution-specific PONV prophylaxis protocol (2015-2017). Sociodemographic and PONV risk data were collected. Primary outcomes were PONV incidence and clinician adherence to PONV prophylaxis protocol. We used descriptive statistics to compare sociodemographics, procedural characteristics, and protocol adherence for patients with and without PONV. Multivariable logistic regression analysis followed by Tukey-Kramer correction for multiple comparisons was used to test for associations between patient sociodemographics, procedural characteristics, PONV risk, and (1) PONV incidence and (2) adherence to PONV prophylaxis protocol. RESULTS: Within the 8384 patient sample, Black patients had a 17% lower risk of PONV than White patients (adjusted odds ratio [aOR], 0.83; 95% confidence interval [CI], 0.73-0.95; P = .006). When there was adherence to the PONV prophylaxis protocol, Black patients were less likely to experience PONV compared to White patients (aOR, 0.81; 95% CI, 0.70-0.93; P = .003). When there was adherence to the protocol, patients with Medicaid were less likely to experience PONV compared to privately insured patients (aOR, 0.72; 95% CI, 0.64-1.04; P = .017). When the protocol was followed for high-risk patients, Hispanic patients were more likely to experience PONV than White patients (aOR, 2.96; 95% CI, 1.18-7.42; adjusted P = .022). Compared to White patients, protocol adherence was lower for Black patients with moderate (aOR, 0.76; 95% CI, 0.64-0.91; P = .003) and high risk (aOR, 0.57; 95% CI, 0.42-0.78; P = .0004). CONCLUSIONS: Racial and sociodemographic disparities exist in the incidence of PONV and clinician adherence to a PONV prophylaxis protocol. Awareness of such disparities in PONV prophylaxis could improve the quality of perioperative care.

Recognizing and Maximizing the Nexus of Perioperative Medicine and Narrative Medicine.

Perioperative medicine remains an evolving, interdisciplinary subspecialty, which encompasses the unique perspectives and incorporates the respective vital expertise of numerous stakeholders. This integrated model of perioperative medicine and care has a wide-ranging set of clinical, strategic, and operational goals. Among these various programmatic goals, a subset of 4, specific, interdependent goals include (1) enhancing patient-centered care, (2) embracing shared decision-making, (3) optimizing health literacy, and (4) avoiding futile surgery. Achieving and sustaining this subset of 4 goals requires continued innovative approaches to perioperative care. The burgeoning field of narrative medicine represents 1 such innovative approach to perioperative care. Narrative medicine is considered the most prominent recent development in the medical humanities. Its central tenet is that attention to narrative-in the form of the patient's story, the clinician's story, or a story constructed together by the patient and clinician-is essential for optimal patient care. If we can view the health care experience through the patient's eyes, we will become more responsive to patients' needs and, thereby, better clinicians. There is a potential clinical nexus between the perioperative medicine practice and narrative medicine skills, which, if capitalized, can maximize perioperative patient care. There are a number of untapped educational and research opportunities in this fruitful nexus between perioperative medicine and narrative medicine.

Value assignment and uncertainty evaluation for anion and single-element reference solutions incorporating historical information.

The National Institute of Standards and Technology, which is the national metrology institute of the USA, assigns certified values to the mass fractions of individual elements in single-element solutions, and to the mass fractions of anions in anion solutions, based on gravimetric preparations and instrumental methods of analysis. The instrumental method currently is high-performance inductively coupled plasma optical emission spectroscopy for the single-element solutions, and ion chromatography for the anion solutions. The uncertainty associated with each certified value comprises method-specific components, a component reflecting potential long-term instability that may affect the certified mass fraction during the useful lifetime of the solutions, and a component from between-method differences. Lately, the latter has been evaluated based only on the measurement results for the reference material being certified. The new procedure described in this contribution blends historical information about between-method differences for similar solutions produced previously, with the between-method difference observed when a new material is characterized. This blending procedure is justified because, with only rare exceptions, the same preparation and measurement methods have been used historically: in the course of almost 40 years for the preparation methods, and of 20 years for the instrumental methods. Also, the certified values of mass fraction, and the associated uncertainties, have been very similar, and the chemistry of the solutions also is closely comparable within each series of materials. If the new procedure will be applied to future SRM lots of single-element or anion solutions routinely, then it is expected that it will yield relative expanded uncertainties that are about 20 % smaller than the procedure for uncertainty evaluation currently in use, and that it will do so for the large majority of the solutions. However, more consequential than any reduction in uncertainty, is the improvement in the quality of the uncertainty evaluations that derives from incorporating the rich historical information about between-method differences and about the stability of the solutions over their expected lifetimes. The particular values listed for several existing SRMs are given merely as retrospective illustrations of the application of the new method, not to suggest that the certified values or their associated uncertainties should be revised.

Utility of the LET-IN-OUT Clinical Decision Support Tool for Medical Risk Stratification Prior to Outpatient Total Hip or Knee Arthroplasty.

BACKGROUND: Musculoskeletal care teams can benefit from simple, standardized, and reliable preoperative tools for assessing discharge disposition after total joint arthroplasty. Our objective was to compare the predictive strength of the Ascension Seton Lower Extremity Inpatient-Outpatient (LET-IN-OUT) tool versus the American Society of Anesthesiologists Physical Status (ASA-PS) score for predicting early postoperative discharge. METHODS: We retrospectively extracted sociodemographic, surgical admission, postoperative day (POD) of discharge, 90-day readmissions, and predictions of the LET-IN-OUT and ASA-PS tools from the electronic records of 563 consecutive hip or knee arthroplasty patients (mean age 65 [SD 9.6], 54% women). Included patients who underwent a total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a single health system between June 2020 and March 2021. We performed descriptive statistics and analyzed predictive values of each tool, defining "early discharge" primarily as discharge before the second postoperative day (POD 2), and secondarily as before 24 hours, and on the same calendar day (POD 0) as surgery. RESULTS: The LET-IN-OUT tool demonstrated superior predictive power among hip and knee arthroplasty patients compared to the ASA-PS tool for discharge prior to POD 2 (positive predictive value [PPV] 89 versus 83%, positive likelihood ratio [+LR] 2.0 versus 1.2), discharge before 24 hours (PPV 86 versus 70%, +LR 2.9 versus 1.2), and discharge on POD 0 (PPV 34% versus 30%, +LR 1.2 versus 1.1). CONCLUSIONS: The Ascension Seton Lower Extremity Inpatient-Outpatient tool predicted patients suitable for early discharge following THA or TKA and did so more effectively than the ASA-PS score.

Complex Growth of Benzamide Form I: Effect of Additives, Solution Flow, and Surface Rugosity.

Understanding crystal growth kinetics is of great importance for the development and manufacturing of crystalline molecular materials. In this work, the impact of additives on the growth kinetics of benzamide form I (BZM-I) crystals has been studied. Using our newly developed crystal growth setup for the measurement of facet-specific crystal growth rates under flow, BZM-I growth rates were measured in the presence of various additives previously reported to induce morphological changes. The additives did not have a significant impact on the growth rates of BZM-I at low concentrations. By comparison to other systems, these additives could not be described as "effective" since BZM-I showed a high tolerance of the additives' presence during growth, which may be a consequence of the type of growth mechanisms at play. Growth of pure BZM-I was found to be extremely defected, and perhaps those defects allow the accommodation of impurities. An alternative explanation is that at low additive concentrations, solid solutions are formed, which was indeed confirmed for a few of the additives. Additionally, the growth of BZM-I was found to be significantly affected by solution dynamics. Changes in some facet growth rates were observed with changes in the orientation of the BZM-I single crystals relative to the solution flow. Of the two sets of facets involved in the growth of the width and length of the crystal, the {10l̅} facets were found to be greatly affected by the solution flow while the {011} facets were not affected at all. Computational fluid dynamics simulations showed that solute concentration has higher gradients at the edges of the leading edge {10l̅} facets, which can explain the appearance of satellite crystals. {10l̅} facets were found to show significant structural rugosity at the molecular level, which may play a role in their mechanism of growth. The work highlights the complexities of measuring crystal growth data of even simple systems such as BZM-I, specifically addressing the effect of additives and fluid dynamics.

Managing a perioperative medicine program.

Perioperative medicine is now a well-recognized albeit still evolving, interdisciplinary subspecialty, which encompasses a wide array of equally invested stakeholders and equally important contributors. The practice of perioperative medicine is fundamentally and optimally a collaborative effort, which aims to provide a comprehensive framework encompassing all aspects of the patient's surgical journey. Moving from a conceptual model of perioperative medicine to an operational perioperative medicine program and clinic requires a methodical management approach. This comprehensive management approach considers a variety of factors, such as defining the mission of a perioperative medicine program, expanding the role of the anesthesiologist and internal medicine hospitalist, recognizing the role of the advanced practice provider, stratifying perioperative management of surgical patients, developing and implementing a program, undertaking a clinical proof-of-concept pilot of a program, scaling up and building out a program, maximizing the electronic health record, leveraging telemedicine and virtual health, and providing adjunctive services.