bluuebunny/crossref_metadata_2025 huggingface dataset:
An Anti-Space Film: Barton Fink
Authors: Akarsu Hikmet Temel
Published: April 2024

Barton Fink, which was awarded the Palme d'Or at the 1991 Cannes Film
Festival, is a highly successful film noir that brings heavy criticism to Hollywood's
inner structure and art circle by taking the “anti-space”(!) theme as a background. It is
also the masterpiece of Joel and Ethan Coen, known as the Coen Brothers, co-creating
many productions in the following years. Barton Fink is at the same time a heavy
criticism, a black satire, and a dark comedy focused on the literary, cinematic, and
artistic universe. The Coen Brothers wrote the script in three weeks, inspired by the
troubles they had in Hollywood while shooting their previous movie (Miller's
Crossing).

The plot of the movie is briefly as follows: Barton Fink, a young screenwriter who had
limited success in New York's literary and artistic circles, and who glowed up on
Broadway, caught the attention of Hollywood. Screenwriter Barton Fink, who accepted
the hard-to-refuse offer and moved to California to work in Hollywood and settled in a
run-down hotel, is now at the service of the movie industry, but at the same time, he is
faced with the terrible facts behind the glittering world of Hollywood reflected on the
screen. The depressing Hotel Earle where he has settled is the first of those dreadful
facts. The hotel contains a nightmarish monotonous array of rooms, closed corridors
whose walls are covered with dull and shoddy sweating, paper, monotonous and lonely
hotel rooms hosting mysterious and troubled guests every night, permeable walls with
voices of a strange frenzy of weird people and a dark and mundane decor filled with
nightmares that destroy all inspiration.

Just as it is shown in the movie, while reflecting the spaces belonging to Hollywood
producers, how luxury, splendor, wealth, and architectural potentiality are wasted
spitefully, recklessly, and lavishly; likewise, the fictional monotony, carelessness,
cheapness, contempt, and misery in industrial buildings that lead to spiritual collapse
are also described with the same skill. Therefore, the Hollywood facts presented to us
by the Coen Brothers instill horror and trepidation both in our architectural thinking and the movie heroes. In other words, everything that is wrong to do in regard to
architecture can be found in a solid artistic criticism hidden under the masterfully
written sequences in the Barton Fink movie. When we consider it in this sense, to give
a name to the architecture, we found there: “antispace” would undoubtedly be the most
correct term. 
“Medianeras” Sidewalls - Gustavo Taretto
Authors: Sarı Tuba
Published: April 2024

Medianeras, which is closely related to architects and urban actors, deals
with many subjects such as the standardization of the individual, standard life, display
windows, lost spaces, capitalism, digitalized world, and relations. The focus of the
narrative in the film, “Medianeras” is defined as the empty and windowless side walls
of the buildings adjacent to the neighboring blocks. While the side walls are shown as
the cause of physical separation between people in the city, these surfaces are also
figured as the dead and vacant spaces of each building that serve no purpose. The
scenario of the film, which begins with the architectural representation and criticism of
the capital city of Argentina, Buenos Aires, is built through the parallel lives of the two
characters. The metaphor of “sidewalls” used spatially in the film corresponds to a
show alternately of the two narratives at similar moments. This spatiotemporal
narrative in the film is linearly fictionalized within the sections of “A Short Autumn”,
“A Long Winter” and “Spring at Last” in the text. In the film, which reflects the
architectural differences of the city of Buenos Aires through the subjective narrative of
the characters Martin and Mariana, similar relationships are defined between urban
structures and people living in the city. The internal monologues quoted through the
voices of Martin and Mariana touch upon many universal city and urbanite problems
on the axis of the individual-society world through the life experiences of the
characters. By establishing a similarity between human life and building, the unplanned
development and architecture of the city are held responsible as the cause of social and
physical problems. By establishing a similarity between human life and building, the
unplanned development and architecture of the city are held responsible as the cause of
social and physical problems. In the face of the legitimation of the internet as a
communication technology, it connects the feeling of loneliness and virtual-real-world
contradictions with unplanned urbanization in metropolises caused by unplanned
urbanization. Whereas the architectural representation of the city is expressed in the
space-time coexistence of the characters, it facilitates comprehension by emphasizing
the experiences of private living spaces and urban public spaces. 
Architecture as a Main Character:Bong Joon-ho’s Parasite
Authors: Karacaoğlu Emre
Published: April 2024

The South Korean black comedy thriller, Parasite, was arguably the most
talked-about movie of 2019. The first South Korean film to win the Palme d'Or and the
first non-English film to win the Academy Award for Best Picture among many other
awards, it is praised almost unanimously as one of the greatest films of the 21st
century. Besides its engaging plot and flawless cinematography, the film was especially
influential with its stark portrayal of the rigid social hierarchy prevalent in modern life.
Having studied sociology at Yonsei University in Seoul and experienced poverty at the
beginning of his own film career, director Bong Joon-ho recounts a comedic, but
extremely bleak story based on the actual reality of our day. He introduces two
families, the poor Kims, and the wealthy Parks, to draw the grim contrast within
distinct social classes. The families are presented in their living spaces and architectural
arrangements, which are a direct reflection of their psychologies. The architecture in
the movie acts not only as a literary tool or plot device but virtually as a main character
of the film, directly influencing the lives of the film’s protagonists.
The Cabinet of Dr. Caligari - Robert Wiene (1920)
Authors: Turan Oktay
Published: April 2024

The Cabinet of Dr. Caligari is one of the early exponents of expressionist
and art cinema. The techniques in the movie function as a kind of mirror rather than a
tool of entertainment. As an autonomous language specific to cinema has not yet been
developed, the relationship with reality is handled on a more subjective level. The
qualities of the space in Dr. Caligari oscillate between two-and three-dimensional
spaces. The built environment has its own reality and aims to reflect a kind of mental
construct in order to constantly express the subjective expression of the creator. The
director uses a frame story to change his perspective. The forms in the built
environment basically appear on the edge, as if they were deformed as a result of a
certain impact. The technique of a frame story has also been used in architecture by
means of intermediate spaces in order to blur the distinction between public and private
in architecture.
Metropolis: From Dystopia To Reality
Authors: İner Gülcan
Published: April 2024

Having begun with consecutive photographic frames depicting real life, the journey of the art of cinema has always left a permanent emotional impact on the audience with visual presentation techniques, surreal plot lines, and spatial organization. Cinema, which is also in connection with other branches of art, also has a special connection with architecture in terms of the fictional spaces that the aspects of the plot occur in. This connection has always kept cinema in a dynamic advancement. The cinema film set that is formed by taking inspiration from a city and the new world order that is realized by taking inspiration from this film set continuously supports each other. Notions of time and space are among the important components of these two branches of art. Architectural structures and cinema films that can challenge years and remain standing have always been constructed with a planning approach that is always ahead of its time. Thus, their effects are still debated even after many years.

In 1927, when it was released, having had a spatial organization that was ahead of its time, Metropolis still remains a source of inspiration for architecture, although it was designed based on a real city in the world. This film, in which we can see the effect of architecture on the cinema clearly, is also among the films that have to be seen in terms of architecture. The film has inspired many artworks around the world with its spatial organization that interpreted the different art trends dominating the time the film was shot.

In this study, in the movie Metropolis, which presents a cross-section from the future, the architectural elements that Fritz Lang, who studied architecture, highlighted with his imagination, and the effect of space on the film are discussed. The effects of art movements and political developments on the world of architecture and cinema will be examined.
Baraka
Authors: Tunalı Selma Kayhan
Published: April 2024

The concept of space in the historical process of cinema and the art of architecture arising from the need for shelter have always been influenced by each other. In this process, the role of movie screenings in experiencing the environment has been essential. The visual experiences in the art of cinema not only construct the past and the future, they also enliven feelings and thoughts and thus leave traces in human memory to the images they show. What we feel and perceive while watching movies are intense visual stimuli that reflect the relationship between architecture and cinema through spatial fiction.
In this study, we will focus on the relationship between space and humans, which is the main element of cinema-architecture interaction. We will try to highlight the effect and dynamism of space perception on human senses. The movie named Baraka in this study was selected considering the human-space relationship and it examines human sense and thought through the concepts of time-space mysticism.
Alice in Wonderland – Tim Burton
Authors: Alik Belma
Published: April 2024

Alice in Wonderland is an animated adventure fantasy movie directed by Tim Burton, written by Linda Woolverton, and published by Walt Disney Pictures in 2010. The main topic of the movie is describing the strange dream that Alice had when she was a child. Her tumultuous imagination and love of miracles inspire us to think the way she does and to awaken the child in us. If there is one epithet in this story that will define the whole topic, it is the term Miracle. Here we encounter various strange things that we do not experience in everyday life, such as disproportion, a mixture of architectural styles combined with various geometric shapes and motifs, and a number of other strange but interesting events and places where the connection between space, time, and humans is emphasized. Many concepts, creative thoughts, and events in the movie can also be interpreted from an architectural point of view. Here first comes the different proportions of the elements and the relationship between humans and space. More specifically, Alice falls into a rabbit hole and from reality comes into a world called The Underworld, which is creative, fantastic, and invented in her dreams. With the help of an elixir and a cookie, her size increases and decreases on a drastic scale compared to the other elements around her. Another controversial scene that can be analyzed from an architectural perspective is the castles of the Red and White Queens. Both castles are in Gothic architecture, but as a result of Alice’s imagination, some shapes, motifs, and colors have been added, breaking the monotony of continuous Gothic architecture elements. Moreover, the strange creatures in the forest, the white rabbit with the clock who is constantly in a hurry, the Mad Hatter, the Cheshire Cat, and the Blue Caterpillar are characters that further enrich the story with miracles. All these elements will be discussed and analyzed in more detail below. The purpose of this analysis is to open the point of view and the inspiring thoughts of the architect with the help of a child's imaginary fantasy world.
Brazil: Ducts And Pipes And Uncanny Gadgets... Or The Absurd Universe Of Being
Authors: Gülmez Nilay Ünsal
Published: April 2024

Brazil, the movie, directed by Terry Gilliam and released in 1985, provides architects and designers with fertile ground to rethink the relationship between infrastructure and the built environment, as well as the role of infrastructure in organizing, operating, and controlling power relations. The infrastructural components, ducts, and pipes, dominate the mise-en-scène of Brazil. They are the most prominent visual element in the film and a versatile metaphor for deciphering the film's material and intellectual codes.

This text will focus on ducts and pipes for reading three interconnected themes in relation to the built and natural environment of the state-machine in Brazil. The first is the dystopic control society that is maintained through the suspicion and horror of terrorists and anarchists. Here, ducts serve as the rhizomatic tools of the control society for surveillance under the authority of Central Services. The second is the capitalist-consumerist system cultivated throughout the film, where ducts signify the taste and status of the people. The third is the depiction of the slippery ground between the real and the imaginary, which is complemented by the ironic and bewildering appearance of ducts and pipes.
Spatial Narrative in the Intercept Of Cinema and Architecture: A Review of Alien (1979) on Storyboards
Authors: Kaya Merve , Artkan Merve
Published: April 2024

The disciplines of cinema and architecture have a common denominator that is related in terms of spatiotemporal content. Movie spaces imply a mutual interaction with the discipline of architecture in terms of the expression of the existing built environment or the design of architecture in the film. The editing of the architecture of the film in this interaction defines an important field of production for the universe design of science fiction cinema. Since designing spaces in sci-fi films requires an innovative approach in the context of the script, various tools are needed to develop the designs in the process of transforming the scenarios into film. Storyboards, which are created to design spaces, events, and characters in the visualization of movies and to build their time flow, are a potential tool for universe design in sci-fi narratives. In this study, Alien (1979), a cult science fiction film, was reviewed through the storyboard sketches of director Ridley Scott and the movie scenes corresponding to these drawings. Knowledge of the setting and design of the creature and how the iconic scenes were designed in the film was explored through storyboards representing the Nostromo spacecraft and the unknown planet. In these storyboards, it has been seen that space and sequences of events are built on a temporal flow through frames, and spatial expressions can be strengthened with visual effects such as movement, color, and light. As a result, it is known that the spatial potentials of storyboards, which are a preliminary draft in the expression of cinematic spaces, are frequently used for architectural expression today, and it is believed that it is important to expand into a design tool.
The Unity of Fictive World and Vision of Reality in the “Blade Runner” Universe
Authors: Ensarioğlu Sebla Arın
Published: April 2024

In this study, the relationship between the fictional world created in Ridley Scott's Blade Runner movie and the reality of 2019, in which the movie takes place, and how consistent the predictions for the future are, are evaluated. This narrative, in which cinematography, architecture, and world of thought are intertwined, is one of the pioneering and cult examples of cyber-punk, techno-noir, and future-noir genre cinema. In the text, in which the intellectual infrastructure and architectural and theoretical references of the dystopian universe created in the movie are examined, the city of Los Angeles in 2019, which the movie reflects, is compared with the cosmopolitan city structure of today’s real world. While trying to analyze the intellectual references made in the subtexts of the film, the relations between the leading thinkers of postmodern philosophy and alternative names of architectural theory and this cult work are examined. Architecture has a place far beyond just creating a visual background in the Blade Runner universe. The periodical and spatial features of the buildings are integrated with the role of characters, and architecture turns into a tool that conveys the nature of the character to the spectator. In this sense, real buildings in the city of Los Angeles are included in the film as well as imaginary designs. Both fictional and real places are extremely effective in reinforcing the characters in the movie. The intricate relationship between places and people is also examined in the text. One of the important concepts that the film leads the audience to question is “othering”. This comparison, conveyed through the human replicant, prompts the spectator to question similar dualities and the boundaries /border setters between them. In addition, the nonstop surveillance/control mechanisms that have penetrated into the deepest cells of the city, both its historical references and its reflections in today's socio-political environment, are discussed.
Organic Architecture and Artificial Lives: Gattaca
Authors: Özmen Cansu Özge
Published: April 2024

This chapter aims to analyze the setting of Gattaca, a 1997 science fiction film written and directed by Andrew Niccol, by highlighting the spatial, architectural, and contextual connections that help catalyze the plot. The film shares features with biopunk, a subcategory of science fiction. Natural spaces are used sparingly, and multiple settings symbolize the transition of human culture from organic to artificial. Natural processes are replaced by scientific innovations, and human beings are seen as a mere means for creating a utopian ideal whereby everyone is engineered to carry certain genetic features to ensure health, longevity, and maximum ability. This creates a homogenous society based on a new hierarchical structure. The protagonist, albeit by illegal means and being a naturally conceived child, fights against the odds stacked against him to fulfill his desires. The natural spaces are used in the film to mark the turning points in the protagonist’s life. Mechanization and standardization of human beings are also emphasized by the spaces in which they live their lives. While the living and working places are devoid of natural light, the workers are deprived of any mimic or expression. The uniformity of the costumes, the futuristic elements being limited to identity scanning devices, the prepotency of arches, and the circular elements in the interior and exterior architecture signal a vicious cycle, and the back streets that function as shelters while running from security are all manifestations of a consistent mise-en-scène that presents barriers in the way of diversification and dynamism in all areas.
Inception: Time In Time, Space In Space
Authors: Alp Neşe Çakıcı
Published: April 2024

Written and directed by Christopher Nolan, Inception was released in 2010, receiving 36 Oscar nominations and ten awards. It became a film that made a name for itself in cinema history. The film was awarded four Oscars in 2011. Inception has a deep meaning for the relativity of time, as it is frequently covered in Nolan's other films (Tenet and Interstellar). In addition to the relativity of time, the search for reality in the film is often questioned. In this sense, the film is an excellent example of how the reality and the relativity of time are explained in the context of space. In Nolan's film, he constructs time over space, and the perception of reality through space is also questioned.

 The film proceeds through the intervention of the subconscious in the dream environment. Interesting fiction in the film is that it is possible to participate in the subconscious through dreams and experience life through space. In this sense, the dream environment in the film gives the ability to be in many places without being anywhere, just like in the metaverse. With this article, the similarities of the film with the metaverse will be revealed. Through the film Inception, the metaverse, which can be easily designed with virtual reality, augmented reality, and augmented reality technologies that emerged in the modern world and are understood to be sustainable and easily accessible during the pandemic process, will be discussed. The film will examine how the dominant idea of the relativity of reality is explained with the perception of time and space.
Jurassic Park
Authors: Dal Seda
Published: April 2024

Architecture is a self-developing process that includes all kinds of social knowledge, which closely follows changes and improvements in social events and technology. As a result of that architecture, action, real and virtual products occur, take forms, and become a part of individuals and society. There are many subelements that support the emergence of these products, in other words, there are many factors contributing to the architectural theory. Cinema, as an effective means of expression among the visual arts, is among the disciplines of architecture. Cinema and architecture are branches of art that are close to each other in terms of designing, producing, and developing technological techniques. This article examines the interaction between cinema and architecture, the analyzed film as a reference is Steven Spielberg's 'Jurassic Park' movie. The Jurassic Park movie was shot and presented to the audience by using all the high technological developments of that period. Many techniques such as special digital effects, virtual reality, and simulation techniques were used. These techniques, which were used also very widely in science-fiction movies, laid the foundation of the METAVERSE which has many users today. The popularity of this virtual world has led to the advancement of the architectural profession in this field. It is possible to see most of the structures designed in the real world but also in the virtual world. Such as cities, places, objects, materials, etc. designed and presented to users in the digital environment. Architecture is also used in the design process of structures in the virtual world, and the spaces are virtualized by using 3D programs. The gigantic creatures in the movie Jurassic Park were designed and animated in line with these principles. Moreover, similar principles were applied in the design process of real buildings and virtual objects in the movie and in the design of spaces in the movie. Within the scope of this study, information about “Virtual Architecture” will be given and the movie “Jurassic Park” will be analyzed through both real architectural and virtual architecture.
Charlie and the Chocolate Factory
Authors: Akansel Sennur
Published: April 2024

Architecture and cinema are two important forms of art in which different perceptions are experienced in the rational world of the observer in terms of experiencing space.

In the definitions of architecture made by many theorists throughout history, it is said that architecture is intertwined with many branches of art, that it is a collaborative process by definition, that it is the most powerful action a person can imagine, and that it is the source of magnificent stories that are not used, waiting to be imagined, visualized, built.

Cinema In the definitions of architecture made by many theorists throughout history, it is said that architecture is intertwined with many branches of art, that it is a collaborative process by definition, that it is the most powerful action a person can imagine, and that it is the source of magnificent stories that are not used, waiting to be imagined, visualized, built. Cinema is only one of the many disciplines that are in a relationship with architecture due to its structure and the semantic and technical components it contains. However, cinema differs from other disciplines in terms of its partnership with architecture because it includes the dimensions of movement, time, and space in addition to incorporating all other art branches.

In the art of architecture, a mental image is transferred from the experimental world of the architect to the mental world of the observer, and the building mediates only as a visual object. Images of the architecture can be immortalized, whereas cinematic images remain the only illusion projected onto the screen. Both branches of art depict frames of life, human interactions, and ways of perceiving the world.

Burton, who pursues a new contextual and semantic setup in his films, is a director known for his extraordinary style that brings images of the imaginary and futureoriented modern world to the cinema audience through real and imaginary possible places, unbuilt, non-existent cinema spaces.

Charlie and the Chocolate Factory film starring Johnny Depp, Helena Bonham Carter, Freddie Highmore, Anna Sophia Robb, James Fox, and Christopher Lee has shared spatial readings of architectural fiction based on the representation of space.
An Examination Of Star Wars Films Through Retro-Futuristic Space And City Setups
Authors: Yenice Melike
Published: April 2024

The common and main elements of cinema and architecture, the individual and the space as the living area of the individual, have the ability to connect these two disciplines and enable them to be in an interactive structure that feeds and develops each other. On the other hand, science-fiction cinema is one of the genres that contributes the most to the field of architecture, with its flexibility enriched by the limits of imagination in terms of making predictions about new ways of life and creating different worlds. In the space opera subgenre of science-fiction cinema, the Star Wars movie series is one of the most important examples that enable the realization of many fictional space designs utilizing technological innovations. George Lucas, the director of the first two trilogies of the series, seems to combine nostalgic and futuristic elements, under the influence of Victorian art, in the techniques he developed in his films and the spaces he created. In Star Wars movies, there are many virtual spaces where spatial elements existing in the real world or belonging to past eras are combined with futuristic spatial assumptions, depending on the differing climatic, physical, and geographical conditions. In his films, he benefited from the narrative-supporting aspect of architectural discipline and spatial fiction; by reinterpreting the architectural styles he used in the film series regarding different living conditions, he also inspired the architectural structures and interior setups of today and the future.

In this study, which aims to examine the retro-futuristic space-city fiction of Star Wars films, the first two trilogies directed by George Lucas will be discussed. Three separate fictional locations -on the Star Wars planet- in films shot in different years are examined in this context, and the aim is to conclude the differentiation in spatial fiction and their effects on the cinematic narrative.
Envisioning Space Throughout The Story Of Human Existence: 2001: A Space Odyssey
Authors: Aydın Ali
Published: April 2024

Architecture and cinema are two disciplines with strong ties to each other. Behind the establishment of these strong bonds, common terminological intersections in use, such as space, light, sound, plan, etc., have an essential place. In Stanley Kubrick's films, the fact that the space plays a vital role at least as much as the actors emphasize the importance of the space in terms of narrative formation. 2001: A Space Odyssey, which deals with the process from the first hominids to today's humans, is a cult film that should be considered since very few dialogues throughout the movie attribute a more dominant role to the space phenomenon. The depictions of space used in the film, which managed to convey millions of year of images to the audience in a short time, were also processed layer by layer parallel to the plot. The audience is involved in the storyline through the transformation of spaces ranging from the hollows where the humanoid apes shelter to the space stations and their ships. Thus, space setup plays an essential role in terms of narrative. This article discusses how this narrative role of the space is constructed and what kind of positions it takes according to the narrative to be created. The ways regarding use of space in the film's scenes were examined, and comparisons were made between the spatial reflections of human behaviors that changed over time. In this context, it is understood that the space has different qualities according to the relationship it establishes with its period. The concept of space not only provides the essential need for shelter but has become more complicated over time. It has evolved from a space formed according to human behavior to an understanding of space that determines human behavior. As the role of the conditions of the period in human life increased, space reached a level that established control over human behavior. The film, which allows this comparison, has the potential to create a different perspective that examines the existential dimension of space beyond our limited understanding of the world.
Pre-Operative Evaluation and Optimization of Geriatric Patient
Authors: Kwiatt Kathleen , Szewczak Robin
Published: April 2024

Worldwide, life expectancy is increasing and people are living longer.
Between 2015 and 2050, the proportion of the world’s population over the age of 60
years is expected to double from 12% to 22% [1]. As our elderly population grows,
more elderly patients now require elective, urgent, and emergent surgery. Elderly
patients are complex due to age-related changes and comorbidities. Anesthesia
provides a critical line of defense for these patients, and this begins with a
comprehensive pre-operative evaluation. Assessment begins with a history and
physical exam and is supplemented with laboratory and clinical data. Special attention
must be given to nutritional status, functional capacity, cardiovascular and pulmonary
function, cognitive function, and emotional well-being. Understanding the physiologic
changes of aging and common pathologies in the elderly helps predict the
pharmacokinetics and pharmacodynamics of anesthetic agents. This understanding also
helps plan for the hemodynamic, ventilatory, and cognitive impacts of anesthesia on
the elderly. Perhaps equally important to determine a patient’s physical condition is
establishing the individual’s goals of care, decision-making capacity, and surrogate
decision-making for anesthesia and surgery.
Postoperative Cognitive Dysfunction (POCD) in Geriatric Patients
Authors: Mele Michele , Takla Magdy , Bhana Nikhil
Published: April 2024

As the world population ages, the number of older patients undergoing
surgery will increase significantly. Postoperative cognitive dysfunction (POCD) and
other perioperative neurocognitive disorders (PND) affecting patients after surgery
have long been recognized in older patients and are considered some of the most
common postoperative complications. POCD has been correlated with significant
morbidity and mortality, and greater healthcare costs. Historically, the lack of
standardized nomenclature used to describe cognitive change after surgery and
anesthesia has made it challenging to conduct systematic reviews or analyze the results
of similar studies to further understand the clinical implications of this disorder. This
has led to minimal recognition of this disorder outside of the specialty of
anesthesiology. Patient and surgery-related risk factors include old age, preexisting
cognitive changes, and emergency surgery amongst others. Proposed etiologies include
postsurgical neuroinflammation, impairment of neurotransmitter systems, and cerebral
vascular events in the perioperative period. The medical literature offers little guidance
to recommend a particular anesthetic to decrease the risk of POCD in the postoperative
patient. Most studies found similar risks of POCD after general and regional anesthesia
techniques. While there is no standardized test for diagnosing preoperative cognitive
impairment, it is critical to identify high-risk patients so that timely interventions can
be made to minimize POCD.
Geriatric Patients with Congestive Heart Failure and Low Ejection Fraction; Non-Cardiac Surgery after CABG
Authors: Marion William , Hikes Anthony , Mahrous Michael
Published: April 2024

In the perioperative care of geriatric patient, it is common to have patients
with heart failure and who have had previous cardiac surgery. In order to safely and
successfully care for these patients it is imperative to understand the pathology and
progression of the disease. Additionally, it is necessary to be able to recognize the signs
and symptoms of heart failure so that it may be recognized in patients who have yet to
be diagnosed in order to determine if further testing or optimization is required.
Furthermore, it is necessary to know the special considerations necessary for the
management of patients with heart failure or previous CABG.
Anesthetic Considerations in Patients After Valve Replacements and Cardiac Stents, with Associated Anticoagulation Concerns
Authors: Patel Abhishek , Mahrous Christopher , Vuckovic Dejan
Published: April 2024

Geriatric patients are a significant proportion of the patients seen in the
perioperative setting. Oftentimes, these patients are presenting for non-cardiac surgery
after undergoing a cardiac procedure previously. Management of these patients starts
with understanding the pathophysiology, surgical intervention, and anesthetic
considerations. This management starts from risk assessment and perioperative
management. In this chapter, risk assessment stemming from a patient’s co-morbid
conditions is taken into account to form an overall risk profile. These conditions help
the anesthesiologist establish a framework to model an anesthetic plan. Notably, a prior
cardiac history, including a history of coronary artery disease (CAD), hypertension
(HTN), and a history of valve disease and possible repair, is prudent. Also discussed is
the need for appropriate intra-operative monitoring in specific situations as well as
anticoagulation guidelines in the pre and post-operative settings.
Pulmonary Hypertension and Geriatric Patients
Authors: Pasch Stuart , Gratz Irwin
Published: April 2024

Pulmonary hypertension is a common and life-threatening condition,
characterized by elevated blood pressure in the pulmonary artery, which supplies blood
to the lungs. This condition is typically classified into five groups based on etiology.
The etiology of pulmonary hypertension in the elderly is complex and multifactorial.
Some of the common causes of pulmonary hypertension in this population include leftsided heart disease, chronic obstructive pulmonary disease (COPD), interstitial lung
disease (ILD), and pulmonary embolism. The initial evaluation determines the cause,
which guides the appropriate treatment. The most common causes in the elderly arise
from left heart disease and the sequela of COPD. Long-standing disease can result in
pulmonary hypertension leading to right heart failure and potentially catastrophic
consequences in a patient population with decreased physiologic reserve. Anesthesia
and surgery in patients with pulmonary hypertension pose a significant risk of
complications including death. Acute right ventricular decompensation can result from
various physiological changes induced by anesthesia and sedation. Adequate risk
assessment and individualized care are essential components of care. Efforts to avoid
increases in pulmonary vascular resistance are keys to anesthetic management.
However, despite the increase of pulmonary hypertension in the geriatric population,
limited studies are dedicated to this group.
Anesthetizing the Critically Ill Geriatric Patient
Authors: Mahrous Christopher J. , Felock Gregory , Ben-Jacob Talia K.
Published: April 2024

Caring for and anesthetizing critically ill geriatric patients requires multiple
special considerations. This chapter will explore the considerations that must be taken
when anesthetizing this geriatric critically ill population. In addition, it will also
describe in detail common critical care scenarios in the geriatric population such as
airway and ventilation management, resuscitation, and sepsis. Finally, some critical
care issues specifically related to the geriatric population such as frailty and end-of-life
considerations will be discussed.
Anesthetic Considerations for Patients with Chronic Neurologic Disorders
Authors: Rana Dhaval , Guzman Felipe
Published: April 2024

Chronic neurological disorders encompass a broad range of challenges for
the surgical and anesthesiology team in the perioperative setting. According to the
World Population Prospects 2019, by 2050, 1 in 6 people will be over 65, from 1 in 11
in 2019 [1]. As our population continues to age, our understanding and ability to
provide medical and surgical services must improve as well. Perioperative strokes are
rare, but they can greatly impact a patient's recovery and function when they occur.
Dementia strongly predicts postoperative complications, higher hospital costs, and 30-
day mortality [2]. Patients with Parkinson’s disease are at a higher risk of perioperative
medical and surgical complications not to mention specific medication regimens that
need to be adjusted to avoid worsening symptomatology. Although rare, a patient
presenting with Amyotrophic lateral sclerosis (ALS), can present with a broad range of
neurologic symptoms, and cardiovascular and pulmonary dysfunction that can be
daunting for any anesthesia provider. In this chapter, we will explore the
comprehensive approach to managing chronic neurologic disorders, including
multidisciplinary care, early identification of potential complications, specialized
medication management, and intraoperative considerations.
Controversies in Geriatric Anesthesia
Authors: Patel Aakash K. , Gratz Irwin , Gourkanti Bharathi
Published: April 2024

There are several controversies when it comes to geriatric anesthesia
including:
1. Determining the appropriate anesthesia technique: Geriatric patients may have
decreased organ function and may be more susceptible to the adverse effects of
anesthesia. There is ongoing debate about the best anesthesia technique for older
adults, with some arguing for the use of regional anesthesia and others advocating for
general anesthesia.2. Perioperative Beta-blockers: The use of perioperative beta-blockers continues to be
debatable. On one hand, evidence suggests beta-blockers may reduce perioperative
cardiac events in the elderly. On the other hand, there are concerns and potential risks,
especially in this population.
3. Cognitive impairment: Older adults may be at increased risk of delirium and
cognitive impairment after surgery. The use of certain medications, such as propofol or
midazolam, may increase the risk of cognitive impairment. There is ongoing debate
about the best way to minimize the risk of cognitive impairment in older adults.
4. Pain management and Frailty: Geriatric patients may have increased sensitivity to
pain and may require higher doses of pain medication. However, older adults may also
be at increased risk of adverse effects from pain medications, such as respiratory
depression.5. Advance care planning and ethical considerations: Geriatric patients may have a
higher risk of complications and death after surgery. Advance care planning, such as
discussing the patient's goals of care and treatment preferences, can help ensure that the
patient's wishes are respected in the event of an emergency. Geriatric patients may have
a decreased ability to make decisions about their care due to cognitive impairment or
other factors. There is ongoing debate about the best way to obtain informed consent
from older adults and ensure that their wishes are respected.6. Cardiac-related controversies including the use of Aminocaproic Acid in CABG
surgeries. There are several studies that have shown reduced bleeding and the need for
blood transfusions, while others have raised concerns about an increased risk of
adverse events, such as renal failure and thromboembolic events.
Ethics and Legal Issues in Geriatric Anesthesia
Authors: Bhana Nikhil , Ocbo Jennifer
Published: April 2024

This chapter discusses the ethical and legal challenges faced by
anesthesiologists in geriatric anesthesia due to medical, economic, and social issues.
Anesthesiologists must exhibit patience, understanding, and compassion in order to
overcome multiple challenges. It is also imperative that they stay up-to-date on the
issues facing this particular population in order to adequately address them efficiently
through collaborative communication and active involvement in patient care.
The Geriatric COVID Patient
Authors: Sayed Osama M. , Schwartz Michael R.
Published: April 2024

The COVID-19 pandemic resulted in a significant impact on healthcare
across the world. The pandemic is caused by the coronavirus SARS-CoV-2 and is
transmitted through respiratory secretions. The geriatric population comprised most
morbidities and mortalities related to COVID-19. Common symptoms include fever,
cough, dyspnea, myalgia, and culminating in acute hypoxic respiratory failure and
acute myocardial injury. Geriatric patients with COVID-19 who require surgery are at a
greater risk of postoperative complications. An assessment of the risks and benefits of
surgical intervention relies on the degree of COVID-19 pathology and the type of
surgery whether emergent or elective. The presence of COVID-19 does not warrant a
change in the modality of anesthesia that would be performed for any given surgery in
the absence of COVID-19.
Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data
Authors: Cummings Camilla , Raja Pushpa , Gabrielian Sonya , Doran Neal
Published: April 2024

Background

Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth’s impacts on SMI care outcomes is mixed, necessitating further investigation.

Objective

We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI.

Methods

We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt).

Results

Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=−4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=−4.49; P<.001; z=−3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=−3.74; P<.001), and continuity of care after a high-risk event (z=−2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=−4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized.

Conclusions

Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation—selected through a health equity lens—may improve quality of care among patients with SMI.
Khaled Hosseini’s A Thousand Splendid Suns: A Saga of Unconventional Relationships
Authors: Qureshi Dr. Sofia Sadique
Published: April 2024

Khaled Hosseini has gained notoriety as a result of his accurate portrayal of his homeland, Afghanistan. His tales are set against Afghanistan’s history, culture, custom, and ethnic variety. His novels’ themes are not limited to a single country or culture; rather, they show the sufferings, struggles, and adventures that are shared by many nations and cultures. A Thousand Splendid Suns follows the lives of two female protagonists, Mariam and Laila, and how their paths cross following a series of dramatic occurrences. The novel then tracks their ongoing relationship and support for one another in Kabul from the 1970s to the 2000s. The tale is set against the backdrop of Afghanistan’s post-Soviet invasion insecurity. It also goes into detail about life under the Taliban rule. The tale highlights the plight of ‘Afghani-women’ over the conflict’s long years. This research paper minutely traces at unconventional relationships and their amalgamation in the novel A Thousand Splendid Suns. The novel is broken into four sections, each of which focuses on different stories. It provides readers with a comprehensive understanding of how women in other countries are treated, and continue to be treated, today.
Pathogenesis, Diagnosis and Therapeutic Strategies for Ventilator-associated Pneumonia
Authors: Thakur Harendra Kumar , Tarai Bansidhar , Bhargava Aradhana , Soni Pankaj , Rath Prasana Kumar , Mishra Bidyut Prava , Jena Manoj Kumar
Published: April 2024

Ventilator-associated pneumonia (VAP) is a major health care associated infection which usually emanates from aspiration, immigration of pathogens from aerodigestive tract, adulterated appliance uses or medications. The mortality rate due to VAP is approximately 13% and the causative organisms are bacteria, viruses, and fungi. Many studies have investigated the causative organisms as Pseudomonas spp., Acinetobacter spp., Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus with varying prevalence. Intensive Care Unit (ICU) admitted patients who are ventilated, are more prone to the infections where the pathogens adhere to the mucosa of lower respiratory tract of mechanically ventilated patients and start infections. Clinical diagnosis based on Clinical Pulmonary Infection Score (CPIS) has poor specificity and microbiological findings takes 48-72 hrs, that can delay the treatment of patients. Lymphopenia on complete blood count is a predictor of mortality in VAP patients, but decreased lymphocyte count occurs in various other infections too. Multiplex PCR is a better diagnostic technique for VAP which can even diagnose atypical bacteria along with other etiological agents. Effectively employing sampling techniques is a vital step in the diagnosis of VAP, enabling the identification of pathogens responsible for lung infections. Furthermore, the emergence of novel therapeutic options approved by regulatory bodies, adds significant advancements in VAP treatment. In this review article, we have performed an in-depth study on the pathogenesis, diagnosis and therapeutic strategies involved in VAP. This study will help the researchers working in this area to design their work appropriately with the updated knowledge on VAP.