The unique structure and multifaceted physicochemical properties of the water molecule, in addition to its universal presence in body compartments, make water a key player in multiple biological processes in human physiology. Since anesthesiologists deal with physiologic processes where water molecules are critical at different levels, and administer medications whose pharmacokinetics and pharmacodynamics depend on interaction with water molecules, we consider that exploration of basic science aspects related to water and its role in physiology and pharmacology is relevant to the practice of anesthesiology. The purpose of this paper is to delineate the physicochemical basis of water that are critical in enabling it to support various homeostatic processes. The role of water in the formation of solutions, modulation of surface tension and in homeostasis of body temperature, acid-base status and osmolarity, is analyzed. Relevance of molecular water interactions to the anesthesiologist is not limited to the realm of physiology and pathophysiology. Deep knowledge of the importance of water in volatile anesthetic effects on neurons opens a window to a new comprehensive understanding of complex cellular mechanisms underlying the practice of anesthesiology.

ObjectivesTraditionally, teaching is part of a clinician’s job. Some practitioners recognize the teaching activity as rewarding. This study explored the ways clinical practitioners experience their journey from clinicians to medical teachers, analyzing their prior experiences of teaching and learning, conceptions of good teaching and learning, perceptions of learning environments, and finally, how those factors influence their approaches to teaching.MethodsData for phenomenographic analysis were collected through semi-structured interviews conducted in Spanish and administered to twelve clinical teachers in three medical schools in Colombia.ResultsThrough sequential phases of analysis, we constructed a conceptual diagram to identify critical concepts, themes, and categories that describe patterns that clinicians adopt during their journey to become medical teachers. We identified two themes and four patterns that describe the journey from practitioner to medical teacher: the identity theme, referring to “what” practitioners showed as the object of the journey and the changing process theme referring to “how” participants adopt changes during the journey. We describe four patterns that describe the journey that physicians adopt when exposed to the experience of clinical teaching.ConclusionIt is possible to identify two themes and to devise at least four patterns in ways of experiencing the journey to medical teacher. These patterns are not a fixed set of characteristics, but rather a spectrum of experiences. Taking into consideration the professional identity of clinical teachers and the path of their teaching process change, it might be possible to devise better strategies for teaching development activities.

BACKGROUND:The representation of women among leaders in the field of anesthesia continues to trail that of their male counterparts. This qualitative study was conducted to understand the pathway of leadership acquisition among women in the field of anesthesiology. METHODS: Using constructivist grounded theory, we sought to determine whether there were specific internal or external factors that were common to women in leadership in the specialty field of anesthesiology, and specifically, how they obtained leadership positions. Semistructured interviews were conducted for data collection. A total of 26 women in leadership positions in anesthesiology participated in this study. RESULTS: The analysis of these interviews resulted in the development of 4 common themes related to career pathways for these women in leadership. Each theme was examined in depth to determine the qualities necessary for individuals to advance in the field and the pathway to obtaining leadership positions. The findings of this study showed that early-career, high-value mentorship and sponsorship were important factors in leadership acquisition. Most participants (n = 20; 76%) had early mentors. Of those with early mentorship, 13 (65%) had high-value mentors, who we define as someone with power or authority. Sponsorship was the leading factor contributing to leadership acquisition. CONCLUSIONS: The results of this qualitative study may serve as a guide for encouraging female anesthesiologists with leadership aspirations. We suggest that the specialty field of anesthesiology institute targeted measures to help increase the percentage of women leadership with formal sponsorship programs at the local and national levels. (Anesth Analg 2023;136:6-12) KEY POINTS• Question: How do female anesthesiologists close the gender leadership gap in anesthesiology? • Findings: Early-career, high-value mentors may be advantageous, and sponsorship is crucial to acquiring leadership positions for women in anesthesiology. • Meanings: Opportunities exist in the specialty field of anesthesiology to reduce the gender gap in leadership with formalized mentorship and sponsorship programs at the local and national levels.

Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis.

The incidence curve of coronavirus disease 19 (COVID-19) shows cyclical patterns over time. We examine the cyclical properties of the incidence curves in various countries and use principal components analysis to shed light on the underlying dynamics that are common to all countries. We find that the cyclical series of 37 countries can be summarized in four principal components which explain over 90% of the variation. We also discuss the influence of complex interactions between biological viral natural history and socio-political reactions and measures adopted by different countries on the cyclical patterns exhibited by COVID-19 around the globe.