Decision support guided fluid challenges and stroke volume response during high-risk surgery: a post hoc analysis of a randomized controlled trial.

Intravenous fluid is administered during high-risk surgery to optimize stroke volume (SV). To assess ongoing need for fluids, the hemodynamic response to a fluid bolus is evaluated using a fluid challenge technique. The Acumen Assisted Fluid Management (AFM) system is a decision support tool designed to ease the application of fluid challenges and thus improve fluid administration during high-risk surgery.

Preparing Residents for Rural Practice and Advocacy: The Experiences of Three Residency Training Programs in the Northeast United States (2009-2023).

Residents that are exposed to rural practice during their training may be more likely to consider working in rural settings after training, whether that be in primary or specialty care. The authors describe 3 programs in northern New England that have had rural rotations and opportunities for residents for decades, and discuss curricular similarities and differences, and workforce outcomes postresidency. In addition, they share a collaborative curriculum and approach to advocacy that brings residents together to share ideas and projects to learn from each other.

Delayed Posterior Fossa Hemorrhage Following a Tangential Gunshot Wound to the Occiput in a Patient With Chronic Liver Disease: A Case Report.

Gunshot wounds (GSWs) to the head and neck are a common etiology of traumatic brain injury. Tangential GSWs (TGSWs) are a subset of GSWs wherein the missile penetrates tissue adjacent to the cranium, causing varying degrees of intracranial injury. Most patients sustaining TGSWs present with relatively benign neurological findings, and while a significant proportion have varying degrees of intracranial hemorrhage (ICH) on computed tomography, these tend to respond well to nonoperative management.

Genomically recoded with optimized functional phenotypes.

Genomically recoded organisms hold promise for many biotechnological applications, but they may exhibit substantial fitness defects relative to their non-recoded counterparts. We used targeted metabolic screens, genetic analysis, and proteomics to identify the origins of fitness impairment in a model recoded organism, C321.∆A.