Sax Institute

Postoperative intensive care unit (ICU) admission affects 15% to 20% of surgical patients and represents a major source of morbidity and health care costs. Current anesthetic dosing relies on empirical guidelines rather than individualized risk assessment. We developed a counterfactual dose-response model to identify optimal fentanyl-propofol combinations. This study aimed to develop and evaluate a stratified, causal machine learning framework using electronic health record data to identify optimal fentanyl-propofol dose combinations and predict postoperative ICU admission risk, enabling precision anesthesia and individualized clinical decision support. We analyzed perioperative electronic health records of 67,134 surgical procedures from UC Irvine Medical Center (2017-2022). A hierarchical learning framework was used to estimate causal effects while controlling for confounding variables. A total of 6 dose-sensitive subgroups were identified through stratified analysis. The primary end point was postoperative ICU admission. High-risk combinations (fentanyl >5 mcg/kg with propofol <1 mg/kg) increased ICU admissions' absolute risk difference by 36% (absolute risk increase; 95% CI 0.351-0.509; P<.001). A total of 6 patient subgroups demonstrated distinct dose-response patterns, with populations considered vulnerable (high glucose, elevated creatinine) showing elevated risk even at standard doses. The optimal dose range for decision-making was determined to be 1.25 to 4.25 mg/kg for propofol and 3.5 to 4.0 mcg/kg for fentanyl. Fentanyl-propofol combinations exhibit complex, nonlinear dose-response relationships with ICU admission risk. High-dose combinations markedly increase risk through synergistic effects, while specific patient subgroups require enhanced monitoring even at standard doses. These findings support the development of individualized dosing algorithms and risk assessment tools that could inform future decision support tools aimed at reducing postoperative ICU use, although their predictive performance and clinical impact would require external validation.

Abstract This article is a proof-of-concept that archaeologists can now disseminate archaeological topics to the public easily and cheaply through video games in teaching situations or in museum or heritage communication. We argue that small but realistic, interactive, and immersive closed- or open-world 3D video games about cultural heritage with unscripted (but guardrailed) oral conversation can now be created by beginners with free software such as Unreal Engine, Reality Capture, and Convai. Thus, developing tailor-made “archaeogames” is now becoming extremely accessible, empowering heritage specialists and researchers to control audiovisual dissemination in museums and education. This unlocks new uses for 3D photogrammetry, currently mostly used for documentation, and could make learning about the past more engaging for a wider audience. Our case study is a small game with two levels, one built around 3D-scanned Neolithic long dolmens in a forest clearing and an archaeologist and a prehistoric person, who are both conversational AI characters. We later added a more open level with autonomous animals, a meadow, and a cave with a shaman guiding the player around specific cave paintings. We tested the first level on players from different backgrounds whose feedback showed great promise. Finally, we discuss ethical issues and future perspectives for this format.

The syntheses of therapeutically important μ-opioid receptor antagonists such as naloxone and naltrexone use noroxymorphone as a key late-stage intermediate, which is manufactured from the poppy-derived alkaloids oripavine or thebaine. However, it would be advantageous to instead use morphine as the starting material, which is cheaper and more abundant. In this paper, we describe the conversion of morphine into a dienol acetate required for installation of the C14 hydroxyl group of noroxymorphone. Our approach is more efficient than previously described approaches and uses a one-pot Albright–Goldman oxidation/dienol acetate formation sequence of an allylic alcohol as the key feature. This synthesis has been successfully applied on multikilogram scales. A brief investigation of the scope of the one-pot Albright–Goldman oxidation/dienol ester formation on other substrates is also described.

Many of the new SaxonJS 3 features have been developed in response to issues that were originally raised by SaxonJS users. "Here's a problem I'm trying to solve. This is what I can do. But what about X? How can I do it with SaxonJS?" Sometimes the SaxonJS 2 solutions may be somewhat unsatisfactory - yes we can code that; but the code isn't especially "pretty", or intuitive, or easy to write... or perhaps there remain limitations... In some cases, there was actually a limitation with the SaxonJS 2 processor - for instance perhaps it is not possible to do what the user wants only with XSLT and IXSL, but instead integrating a JavaScript solution is required. In other cases, the SaxonJS 2 solution is perhaps just rather complicated, and requires putting features together in an unfamiliar way. In this paper we will look at how new SaxonJS 3 IXSL features can be used to write much cleaner solutions for some problems which were tricky with SaxonJS 2.

This article examines the ideas of Inspector Jens Jersild on sexuality, youth and childhood and his broader impact on sex education. Prior research has identified Jersild as a central figure in the debate on sexuality during the 1950s and has indicated his impact on sex education. I examine Jersild's ideas on sexuality, youth and childhood and assess his influence on the governmental guidelines for sex education in 1961 and 1971. Through sex education, Jersild sought to foster heterosexuality and discourage other sexual categories. The guidelines reflect a governmental desire to institutionalize Jersild's ideas yet also illustrate a temporal shift in the conceptualization of sexuality.

Since 2018, new excavations in the Lower City of Artaxata, Armenia, have yielded thousands of animal bones. They provide valuable inside into the life of the ancient city and the relations between humans and animals in the time between the second century BC and the second century AD. The analysis of the bones is still ongoing. For now, the data proves a heavy focus on sheep and goats to a point where we can speak of specialized production. Cattle was also present and added both to the diet and to help in daily chores such as ploughing and pulling of heavy loads. Chickens and geese were kept within the ancient city. Horses, dogs and pigs are rare. For horses and dogs, this may be due to their special status among the domestic animals. Maybe pigs were sparsely eaten because the effort to raise them was higher than for sheep and goat. Hunted animals such as fox, deer, hare, and rabbit describe an open landscape, while small rodents like the jird point to agriculture. Wild and domestic species show different levels of closeness between humans and animals in ancient Artaxata.

European settlers in colonial Kenya in the beginning of the 20th century embodied a significant contradiction: While advocating vividly for the preservation of a ‘pristine nature’, the settlers hunting and agrobusiness activities are the single most important factor for a rapid decline of wildlife population in the area. This article investigates the meaning of hunting and conservation practices for the establishment and consolidation of a White settler elite in Laikipia, Kenya. The argumentation is based on episodic evidence from the biography of Lord Delamere, an influential first settler, hunter and conservationist, written by Elsbeth Huxley in 1935. It investigates the practices around ‘managing’ wildlife from an ideological and economical dimension. I argue that the transplantation of European aristocratic traditions of ‘The Hunt’ and the understanding of nature and society as separate spheres delegitimized pre-colonial modes of nature-use and reinforced a racist hierarchy of societies. The systematic dispossession of precolonial landholders, their forceful but selective inclusion in the settler economy and the eradication of wildlife for profitable agrobusiness irreversibly degraded the various forms of precolonial economies and consolidated the settler’s presence in Laikipia until today.

This article examines Danmarks Radio’s portrayal of the Portuguese colonial state, specifically during the Portuguese colonial war. From the collected archive material, it has been possible to identify three main phases of the reporting. The first phase, from 1961, was uncritical of the conflicts that were erupting the in Portuguese African colonies. From the mid-1960’s a second phase started to emerge, where analysis and criticism in the reports appeared. By 1970, the coverage of the different wars evolved into a third phase, which was committed anti-colonial.