Abstract:The Taiwan Strait (TS) is one of the main sources of phosphate that supports the large fish catches of the phosphate-limited East China Sea (ECS). The Penghu Channel is the deepest part of the TS, and most of the flow of the TS towards the ECS is principally through this channel. Empirical equations that are based on measurements made during 19 cruises (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) were combined with water velocity, salinity, and temperature, which were modeled using HYCOM (the Hybrid Coordinate Ocean Model) to obtain the annual fluxes for total alkalinity (TA), dissolved inorganic carbon (DIC), nitrate plus nitrite, phosphate, and silicate fluxes. The TA and DIC are mainly transported in the top layer (0-55 m) because the current is much stronger there than in the bottom layer (55-125 m) whereas the TA and DIC concentrations in the top layer are only slightly smaller compared with the bottom layer. In contrast, the nitrate plus nitrite flux is mainly transported in the bottom layer because the concentrations are much higher in the bottom layer. Generally, nutrient flux increases with the Pacific Decadal Oscillation (PDO) index, but TA and DIC fluxes increase as the PDO index decreases.
Objective: Post-operative ileus (POI) is a common and potentially serious complication after surgery. We assessed the incidence and identified predictors of POI in older surgical patients.Design: A retrospective observational study.Setting: University of California-San Francisco electronic medical record data.Participants: Opioid-naïve, noncancer patients, aged 65 and older, who underwent elective surgery in the period 2017-2019.Exposure: Administration of opioid analgesics per day of hospitalization in opioid naïve patients.Main outcomes measure: Incidence of POI and likelihood of developing POI.Results: In the study period, 3 percent of opioid naïve patients developed POI. Patients with POI used on average 197.1 oral morphine equivalents (OMEs) per day of hospitalization compared to 82.5 OME in patients without POI (p = 0.013). Yet, there were not statistically significant differences in post-operative pain scores between patients with and without POI. General surgery (p = 0.0031), length of surgery (p = 0.0031), and hospital length of stay (p 0.0001) were significant predictors of the risk for developing POI. Adjusted inpatient administration of more than 90 OME per day of hospitalization was associated with a four times greater risk for developing POI (p = 0.016). Developing POI was associated with 6.5 (95 percent confidence interval: 5.2-7.8) additional days of hospitalization among patients who developed POI compared to patients who did not develop POI (p 0.0001).Conclusions: Adjusted inpatient administration of more than 90 OME significantly increased the risk for developing POI in opioid-naïve older patients. Developing POI after surgery significantly increased the hospital length of stay. Optimizing inpatient administration of opioids may prevent opioid use-related POI and longer hospitalizations.
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