Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.

Increasing Stability of Lithium-Ion Batteries with Ordered Graphene Silicon Negative Electrodes

Currently, lackluster battery capability is restricting the widespread integration of Smart Grids, limiting the long-term feasibility of alternative, green energy conversion technologies. Silicon nanoparticles have great conductivity for applications in rechargeable batteries, but have degradation issues due to changes in volume during lithiation/delithiation cycles. To combat this, we use electrochemical deposition to uniformly space silicon particles on graphene sheets to create a more stable structure. We found the process of electrochemical deposition degraded the graphene binding in the electrode material, severely reducing charge capacity. But, the usage of mechanically mixing silicon particles with grapheme yielded batteries better than those that are commercially available.

Invivo Changes In The Activity Of Gill ATPases And Hemolymph Ions Of Carcinus Maenas Exposed To p p'-DDT And Reduced Salinities

1. Haemolymph osmoregulation by the shore crab, Carcinus maenas was confirmed over a range of salinities. 2. Na+K+-ATPase and Mg2+-ATPase activities in gill tissue increased with a decrease in salinity. 3. Na+K+-ATPase and Mg2+-ATPase activities were inhibited after exposure to p,p′-DDT. 4. K+ ion levels of the haemolymph remained unchanged, but Na+ ion levels were affected after 7 hr when transferred from 100 to 5% SW after exposure to DDT.

The Effects Of Reduced Salinity On Colonial Growth And Membership In A Hydroid

The effect of different salinity levels on colonial growth and gonozooid frequency of the hydroid Campanularia flexuosa Hincks has been studied. It is shown that the usual cumulative presentation of growth data tends to obscure evidence of acclimation and other features of importance to an interpretation of adaptations of the growth process to salinity changes. A method of analysis is described that not only demonstrates acclimation, but apparently shows how growth is controlled after disturbance by changes in salinity. One other response to reduced salinity and other unfavourable changes in water chemistry is an increase in gonozooid frequency due to the diversion of resources from the formation of new hydranths.

Reduced pH sea water disrupts chemo-responsive behaviour in an intertidal crustacean

Chemoreception is a key activity by which many aquatic animals perceive their environment, and therefore abiotic disruptions to this process could have serious impacts on the survival and fitness of individuals, and on species interactions. Hermit crabs are subject to cyclical reductions in the pH of the water in the intertidal rock pools that they inhabit. Such reductions may be further exacerbated by ongoing ocean acidification and/or leakage of carbon dioxide from geological storage sites and coastal upwelling events. Here we test the chemo-sensory responses of the hermit crab Pagurus bernhardus (Linnaeus) to a food odour under reduced pH conditions (pHNBS = 6.80). Acidifying the odour had no effect on its attractiveness indicating no permanent degradation of the cue; however, the pH of the sea water did affect the crabs' responses. Hermit crabs kept and tested in reduced pH sea water had lower antennular flicking rates (the ‘sniffing’ response in decapods); were less successful in locating the odour source, and showed an overall decline in locomotory activity compared to those in untreated sea water. Analysis of their haemolymph revealed a greater concentration of chloride ions ([Cl−]) in the reduced pH treatment group, suggesting iono-regulatory disruption; however, there was no correlation between [Cl−] and locomotory activity, suggesting a specific effect on chemoreception. This study shows that the chemo-responsiveness of a crustacean may be influenced by both naturally occurring pH fluctuations and future anthropogenically-induced changes in ocean pH.

1H NMR metabolomics reveals contrasting response by male and female mussels exposed to reduced seawater pH, increased temperature and a pathogen

Human activities are fundamentally altering the chemistry of the world's oceans. Ocean acidification (OA) is occurring against a background of warming and an increasing occurrence of disease outbreaks, posing a significant threat to marine organisms, communities, and ecosystems. In the current study, (1)H NMR spectroscopy was used to investigate the response of the blue mussel, Mytilus edulis, to a 90-day exposure to reduced seawater pH and increased temperature, followed by a subsequent pathogenic challenge. Analysis of the metabolome revealed significant differences between male and female organisms. Furthermore, males and females are shown to respond differently to environmental stress. While males were significantly affected by reduced seawater pH, increased temperature, and a bacterial challenge, it was only a reduction in seawater pH that impacted females. Despite impacting males and females differently, stressors seem to act via a generalized stress response impacting both energy metabolism and osmotic balance in both sexes. This study therefore has important implications for the interpretation of metabolomic data in mussels, as well as the impact of environmental stress in marine invertebrates in general.

Pathogenic challenge reveals immune trade-off in mussels exposed to reduced seawater pH and increased temperature

Mussels tolerant to seawater pH's that are projected to occur by 2300 due to ocean acidification.•Exposure to pH 6.50 reduced mussel immune response, yet in the absence of a pathogen.•Subsequent pathogenic challenge led to a reversal of immune suppression at pH 6.50.•Study highlights the importance of undertaking multiple stressor exposures.•Shows a need to consider physiological trade-offs and measure responses functionally