Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University.

Background: Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, longterm cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia). Methods: This multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary outcomes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression. Results: The incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38e0.88]; P¼0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS 6 vs 20%; P<0.001).

This study utilized a hypobaric chamber to compare the effects of mild hypobaria (MH; 50 mmHg, approximately 580 m altitude) on blood O2 status and maximal O2 consumption (VO2max) in 9 untrained and 11 trained (T) cyclists with VO2max values of 51 +/- 3 and 77 +/- 1 ml.kg-1.min-1, respectively. In both groups, arterial O2 saturation (SaO2) decreased significantly during maximal exercise, and this effect was enhanced with MH. Both these responses were significantly greater in the T cyclists in whom the final SaO2 during MH was 86.5 +/- 0.9%. When the group data were combined, approximately 65% of the variance in SaO2 could be attributed to a widened alveolar-arterial Po2 difference. The arterial PO2 during maximal exercise at sea level in the T group was on the steeper portion of the hemoglobin-O2-loading curve (T, 68.3 +/- 1.3 Torr; untrained, 89.0 +/- 2.9 Torr) such that a similar decrease in arterial PO2 in the two groups in response to MH resulted in a significantly greater fall in both SaO2 and calculated O2 content in the T group. As a consequence, the VO2max fell significantly only in the T group (mean change, -6.8 +/- 1.5%; range, + 1.2 to - 12.3%), with approximately 70% of this decrease being due to a fall in O2 content. This is the lowest altitude reported to decrease VO2max, suggesting that T athletes are more susceptible to a fall in inspired PO2.

Shape memory polymer foams have significant potential in biomedical and aerospace applications, but their thermo-mechanical behavior under relevant deformation conditions is not well understood. In this paper we examine the thermo-mechanical behavior of epoxy shape memory polymer foams with an average relative density of nearly 20%. These foams are deformed under conditions of varying stress, strain, and temperature. The glass transition temperature of the foam was measured to be approximately 90 °C and compression and tensile tests were performed at temperatures ranging from 25 to 125 °C. Various shape recovery tests were used to measure recovery properties under different thermo-mechanical conditions. Tensile strain to failure was measured as a function of temperature to probe the maximum recovery limits of the foam in both temperature and strain space. Compression tests were performed to examine compressibility of the material as a function of temperature; these foams can be compacted as much as 80% and still experience full strain recovery over multiple cycles. Furthermore, both tensile strain to failure tests and cyclic compression recovery tests revealed that deforming at a temperature of 80 °C maximizes macroscopic strain recovery. Deformation temperatures above or below this optimal value lead to lower failure strains in tension and the accumulation of non-recoverable strains in cyclic compression. Micro-computed tomography (micro-CT) scans of the foam at various compressed states were used to understand foam deformation mechanisms. The micro-CT studies revealed the bending, buckling, and collapse of cells with increasing compression, consistent with results from published numerical simulations.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.