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Numerous studies have characterized the pain reported by patients with advanced illness in terms of descriptors such as severity, but few have measured pain-related distress. Distress may be important in the clinical approach to pain. To evaluate pain-related distress among adult patients with advanced illness and pain following enrollment in an urban, specialist-level, community-based palliative care program.
In a retrospective cross-sectional analysis, data were extracted from the electronic health records of all patients who were able to complete the pain item from the Condensed Memorial Symptom Assessment Scale at the start of care. Bivariate and multivariate analyses evaluated the associations between distress and both sociodemographics and disease-related information.
The 506 patients completing the pain item had a mean (SD) age of 70.7 years (13.8); 64.2% were women, 32.1% were Hispanic, 32.6% were white, and 27.7% were black. Of the 503 patients who indicated some level of distress on a 0–4 scale, 221 (43.7%) had high distress, defined as a score ≥3 (“quite a bit” or “very much”). Cancer diagnosis and poor performance status (unable to care for self) were predictors of high pain-related distress (both p < 0.05).
Significance of results
Among patients with advanced illness who reported pain at the start of care by a specialist palliative care program, high pain-related distress was common, particularly among those with cancer or poor physical function. Further studies are needed to explore the extent to which pain-related distress should inform the assessment and management of pain.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
The objective of this experiment was to measure the effects of preand postnatal supplementation of sows with an algal source of docosahexaenoic acid (DHA) on the pre and post–weaning performance of their piglets. The experiment was of 2 x 2 factorial design, with DHA supplementation of the sow diet (3g DHA/kg feed) during the last 4 weeks of pregnancy and/or 4 weeks of lactation. There was a significant positive effect (P<0.05) of lactation DHA on weaning weight. Piglets from sows which had received DHA supplement in gestation were heavier throughout the post–weaning period than controls (P<0.05), as were piglets whose mothers received DHA in lactation (P<0.05). When age and weight at weaning were used as covariates in the model, the liveweight gain in week 1 and over the whole 26 day post–weaning period were significantly greater (P<0.05) for piglets from sows which had received DHA supplement in gestation. It is concluded that DHA supplementation of sow diets can improve piglet performance.
The development of adverse behaviour in group–housed growing/ finishing pigs with intact tails was studied in a straw–flow housing system and in a part–slatted system with a commercial enrichment object. Food intake, body weight and behaviour were monitored over the finishing period, with tail biting outbreaks defined as an occasion where three or more pigs within a group had freshly damaged tails and tail biting behaviour was ongoing. Data from the two systems were analysed to identify tail–biting outbreaks and behavioural changes over time. Levels of pig manipulation were higher in the part–slatted system. Over time, pigs in both systems showed reduced interest in the enrichment provided, but not in each other. Despite the presence of the enrichment device, tail biting occurred in all groups in the part–slatted system, but only 1/12 groups in the straw–flow system. The amount of time occupied by manipulation of the enrichment provided was very significantly higher for straw than for the commercial object. Better design of enrichment strategies is therefore needed and should be based on species–relevant requirements.
In order to reduce ammonia emissions from pig housing systems, the Council of Europe proposes the use of part slatted flooring in preference to fully slatted flooring, but the effects of such changes on the health and welfare of pigs in the UK has not been defined. The aim of this experiment was to investigate the effects of different floor types on the emission of ammonia, behaviour and welfare, physical performance and respiratory and enteric health of growing/finishing pigs. This involved three replications of five treatments: 1) UK fully-slatted, 2) UK fully–slatted with rubber matting over 50% of the slats, 3) UK fully–slatted with “structural” modifications which involved “paving” over 50% of the floor and partitioning off the slurry channel beneath the solid floor, 4) UK part–slatted, and 5) novel Dutch partslatted with UK pig stocking density. Groups of 10 pigs (balanced for gender) weighing approximately 40kg were on–test for 10 weeks.
The immediate postweaning period in pigs is often characterised by a reduced and variable food intake, digestive disorders and poor growth and development. Historically such effects were reduced by the use of in-feed antibiotic growth promoters (AGPs), copper sulphate and zinc oxide to enhance the efficiency of feed conversion and hence maximise nutrient capture. However from January 2006 the routine use of in-feed AGPs was banned and, due to concern over environmental pollution, levels of inclusion of heavy metals are limited by regulation and likely to be further reduced in the future. Weaning pigs at a later age has been suggested as an approach to reduce the potentially negative effects of the AGP ban on the national herd. The objective of the AGEWEAN programme of research was to investigate the effects of weaning age (4, 6 and 8 weeks) in both an indoor and outdoor lactation environment on the biological and economic efficiency of production where diets contain no AGPs and lower levels of copper (<25ppm added) and zinc (<100ppm added).
Tail biting is a widespread adverse behaviour that occurs in growing pigs but, as of yet, no one knows what initially encourages the development of this behavioural problem. It has been suggested that tail biting is linked to a behavioural predisposition, exacerbated by environmental inadequacy, or a nutritional deficiency such as inadequate protein or minerals. Using a model tail test, Fraser (1987, 1991) demonstrated an experimental link between mineral or protein dietary deficiencies and an increased attraction to blood. Using this test, Fraser demonstrated that large individual variation exists between pigs in the extent of their attraction to blood. The current experiment extended this tail test to investigate the nature of the attraction to blood, and to examine factors that may be related to tail biting predisposition.
The performance of tail biting and other harmful social behaviours is a common problem on pig farms. Many risk factors relating to tail biting have been identified, but the problem remains intractable. One contributory factor may be the genetic makeup of pigs but, as with most pig behaviour, there has been little research into the genetic basis of its expression. The aim of the current experiment was to investigate the genetic component of harmful social behaviours, such as tail biting, by assessing breed differences in the predisposition to perform these behaviours.
Extensive research into human-animal interactions, particularly in the pig industry, has led to the proposal that high fear of humans, through a stress response, can limit an animal’s growth, reproduction and welfare (Hemsworth et al., 1993). In a recent study in the Australian dairy industry, a significant negative between-farm correlation was found between the avoidance of an experimenter by cows in a standard test and milk yield of the farm, suggesting that fear of humans may also have implications for the productivity of dairy cows (Breuer et al., 2000). The behaviour of stockpeople is a likely factor affecting fear of humans in dairy cows (Breuer et al., 2000). It was the aim of this experiment to investigate the effects of handling on the stress physiology and behaviour of dairy heifers.
Recent research suggests that the genetic makeup of a pig may contribute to the expression of tail biting (Breuer et al., 2002). To date there has been little investigation into the genetics of tail biting. A significant population of tail biters was found at a commercial pig breeding farm at which an experiment on the genetic basis of the expression of harmful social behaviour was being performed. As pedigree data for each pig on the farm were available, the opportunity was taken to investigate the heritability of tail biting by recording the perpetrators of clinical tail biting.
King George Island is the largest of the South Shetland Islands, close to the tip of the Antarctic Peninsula. The annual mean temperature on the island has increased by 1°C during the past three decades, and the ice cap that covers the majority of the island is sensitive to climatic change. We present data from two field campaigns (1997 and 2007): 700 km of global positioning system (GPS) and ground-penetrating radar (GPR) profiles were collected on Arctowski Icefield and on the adjacent central part. The data were analysed to determine the surface and bed topography and the thermal regime of the ice. Average ice thickness is 250 m and maximum thickness is 420 m. The GPR profiles show isochrones throughout the ice cap which depict the uparching of Raymond bumps beneath or close to the ice divides. A water table from percolation of meltwater in the snowpack shows the firn-ice boundary at ∼ 3 5 m depth. The firn layer may be temperate due to the release of latent heat. In the area below 400ma.s.l., backscatter by water inclusions is abundant for ice depths below the water table. We interpret this as evidence for temperate ice. Scatter decreases significantly above 400 m. Ice temperatures below the water table in this part of the ice cap are subject to further field and modelling investigations.
The cryosphere is an essential component of the global climate system, equally affecting climate processes significantly and being subject, and particularly sensitive, to changes in climate conditions. Numerical models are an important tool for assessing climate-change impacts on the Antarctic ice–sheet–ice–shelf–ocean system. They not only complement field and satellite remotesensing investigations but are often the only feasible alternative for addressing some of the important parameters and processes. Over the last few years, our group has made significant progress in developing and applying innovative numerical methods. In this paper, we provide a brief overview of some of the methods employed and the major results obtained for a number of case studies in the Atlantic sector of Antarctica.
OBJECTIVES/SPECIFIC AIMS: Tissue engineered tracheal grafts (TETG) could provide a life-saving cure for children with long segment airway defects. Computational fluid dynamics (CFD) is a novel and promising technique used to evaluate TETG performance. This pilot study examines the correlation of objective CFD simulations with subjective respiratory symptoms in a TETG large animal model. METHODS/STUDY POPULATION: Three-dimensional geometries of 1 TETG implanted sheep trachea were reconstructed from serial fluoroscopic images, allowing analysis with CFD simulations. Peak flow velocity (PFV) and peak wall shear stress (PWSS) across the graft as well as changes secondary to stenting were determined. CFD metrics were compared with respiratory symptoms seen on exam. RESULTS/ANTICIPATED RESULTS: Two weeks after implantation, the animal developed respiratory distress, which correlated with PFV and PWSS elevations. Although the intraluminal graft appearance changed minimally after dilation, PFV and PWSS decreased across the graft (4.5–0.8 m/s and 0.9–0.1 Pa, respectively). Long-term TETG stenting with dilation returned PFV and PWSS to baseline (0.8–0.3 m/s and 0.1–0.01 Pa, respectively), which correlated with immediate symptom resolution. DISCUSSION/SIGNIFICANCE OF IMPACT: CFD is a noninvasive modality, which allows the evaluation of airflow metrics of symptomatic TETG recipients. This diagnostic tool will permit planned interventions and graft design optimization.
The prevalence of depression in rural Ugandan communities is high and yet detection and treatment of depression in the primary care setting is suboptimal. Short valid depression screening measures may improve detection of depression. We describe the validation of the Luganda translated nine- and two-item Patient Health Questionnaires (PHQ-9 and PHQ-2) as screening tools for depression in two rural primary care facilities in Eastern Uganda.
A total of 1407 adult respondents were screened consecutively using the nine-item Luganda PHQ. Of these 212 were randomly selected to respond to the Mini International Neuropsychiatric Interview diagnostic questionnaire. Descriptive statistics for respondents’ demographic characteristics and PHQ scores were generated. The sensitivity, specificity and positive predictive values (PPVs), and area under the ROC curve were determined for both the PHQ-9 and PHQ-2.
The optimum trade-off between sensitivity and PPV was at a cut-off of ≧5. The weighted area under the receiver Operating Characteristic curve was 0.74 (95% CI 0.60–0.89) and 0.68 (95% CI 0.54–0.82) for PHQ-9 and PHQ-2, respectively.
The Luganda translation of the PHQ-9 was found to be modestly useful in detecting depression. The PHQ-9 performed only slightly better than the PHQ-2 in this rural Ugandan Primary care setting. Future research could improve on diagnostic accuracy by considering the idioms of distress among Luganda speakers, and revising the PHQ-9 accordingly. The usefulness of the PHQ-2 in this rural population should be viewed with caution.
Healthcare workers (HCWs) reporting no history of varicella frequently receive varicella vaccination (vOka) if they test varicella-zoster virus (VZV) immunoglobulin G (IgG) negative. In this study, the utilities of VZV-IgG time-resolved fluorescence immunoassay (VZV-TRFIA) and a commercial VZV-IgG purified glycoprotein enzyme immunoassay (gpEIA) currently used in England for confirming VZV immunity have been compared to the fluorescent-antibody-to-membrane-antigen assay (FAMA). A total of 110 HCWs received two doses of vOka vaccine spaced 6 weeks apart and sera collected pre-vaccination (n = 100), at 6 weeks post-completion of vaccination (n = 86) and at 12–18 months follow-up (n = 73) were analysed. Pre-vaccination, by FAMA, 61·0% sera were VZV IgG negative, and compared to FAMA the sensitivities of VZV-TRFIA and gpEIA were 74·4% [95% confidence interval (CI) 57·9–87·0] and 46·2% (95% CI 30·1–62·8), respectively. Post-completion of vaccination the seroconversion rate by FAMA was 93·7% compared to rates of 95·8% and 70·8% determined by VZV-TRFIA and gpEIA, respectively. At 12–18 months follow-up seropositivity rates by FAMA, VZV-TRFIA and gpEIA were 78·1%, 74·0% and 47·9%, respectively. Compared to FAMA the sensitivities of VZV-TRFIA and gpEIA for measuring VZV IgG following vaccination were 96·4% (95% CI 91·7–98·8) and 74·6% (95% CI 66·5–81·6), respectively. Using both FAMA and VZV-TRFIA to identify healthy adult VZV susceptibles and measure seroconversion showed that vOka vaccination of HCWs is highly immunogenic.
Bats are unique among mammals for their ability to fly. A substantial body of research has focused on understanding how they do so, and in 1990, Norberg's landmark volume provided an up-to-date understanding of diverse aspects of bat flight (Norberg, 1990). Building on work accomplished before 1990, our understanding of bat flight has changed significantly in the last two decades, and warrants an updated review. For example, many hypotheses about how bats fly were based either on aircraft aerodynamics or on studies of birds. In some respects, these predictions did fit bats well. However, recent advances in the study of bat flight have also revealed important differences between winged mammals and other fliers. Although we have, of course, always known that a bat is neither a bird nor a plane, the significance of the differences among bats and all other flyers are only now becoming clear.
In this chapter, we provide an overview of the morphology of bats from the perspective of their unique capacity for powered flight. Throughout the chapter, we provide references to classic literature concerning animal flight and the bat flight apparatus, and direct readers to sources of additional information where possible. We focus on relatively newer work that over the last 20 years has begun to change the ways in which we understand how bats carry out their remarkable flight behavior, and that has altered the way we understand the structural underpinnings of bat flight.