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Learning Objectives: Contrast the neural and local control of circulations through special regions. Compare the physiological significance of variation in circulations through special regions. Content Overview: This lecture provides a comprehensive exploration of circulation in specialized regions of the body, including coronary, cerebral, splanchnic, cutaneous, fetal, skeletal muscle, and pulmonary circulations. The physiological and anatomical considerations, regulation mechanisms, and unique features of each type of circulation are discussed. Key concepts such as autoregulation, local metabolic factors, and neural influences are covered in detail. Key Topics: Coronary Circulation: Anatomy and physiology of coronary blood supply. Phasic changes in blood flow during systole and diastole. Regulation by autonomic nervous system and local metabolic factors (hypoxia, adenosine). Cerebral Circulation: Control by local metabolic factors (CO2, H+). Autoregulation and hyperemia. Anatomy of cerebral blood supply and special features of cerebral blood vessels. Splanchnic Circulation: Anatomy and regulation of blood flow to the gastrointestinal organs. Role of sympathetic and parasympathetic nervous systems. Chemical factors and the concept of autoregulatory escape. Cutaneous Circulation: Thermoregulatory function and dense nervous innervation. Mechanisms of vasodilation and vasoconstriction. Blood reservoir function and responses to mechanical stimuli. Fetal Circulation: Unique aspects of fetal blood flow including umbilical vessels, ductus venosus, foramen ovale, and ductus arteriosus. Changes in circulation at birth and the stimuli for these changes. Skeletal Muscle Circulation: Regulation during rest and exercise. Role of nervous and local metabolic control. Circulatory adjustments during physical activity. Pulmonary Circulation: Characteristics and regulation of pulmonary blood flow. Zones of blood flow in the lungs and the effect of gravity. Response to hypoxia and other factors influencing pulmonary vascular resistance

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Thoracotomy is the surgical procedure with an incision made to access the pleural space and the contents of the thoracic cavity. Given the structures to be accessed with in the cavity, different incisions have been established to easy the procedure and these incisions qualify the types of thoracotomies to be studied hereunder. PRE OP OPTIMIZATION FOR SPECIFIC FACTORS The outcome of surgical procedures is not measured only by clinical end points but also shorter stays and lower costs. Patients’ discharge is delayed commonly due to inadequate pain relief, infection, arrhythmias, prolonged air leak and debility. Many complications that occur from thoracic operations can be anticipated. An aggressive preoperative work up mitigates morbidity and shortens convalescence. APPROACH CONSIDERATIONS There are about three principles that can guides the choice of the thoracotomy incision to be used I. Adequate exposure must be achieved. The choice of incision is aided by a thorough understanding of the surface anatomy and a comprehensive review of the radiographic images that are obtained preoperatively. II. Chest-wall function and appearance should be preserved to the extent possible. This principle include non-spreading video-assisted thoracoscopic surgery (VATS) procedures, muscle-sparing techniques, avoidance of excessive rib retraction, and rib preservation when possible. III. The third principle is that closure must be meticulous and appropriate. Strict layered closure is the rule for thoracic surgical incisions. Every effort should be made to approximate the individual divided chest-wall muscles in appropriate layers; otherwise, a significant delay in the recovery of range of motion (ROM) may result. Care must be taken to avoid over approximating the ribs and to prevent an override; this will help minimize postoperative pain. POST-OPERATIVE CARE AND MONITORING

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Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits. To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups. Technology For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did. While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis. Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad. Age and Gender When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same. Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers. Race Affects Attitudes As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).

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From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world. With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively. The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage. Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience. See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers See the original article on Forbes here: http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b

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Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world. Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance. For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age. Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.

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