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Introduction: Given the current opioid crisis, caregivers have mounting fears regarding use of opioid medication in their children. Since caregivers are often the gatekeepers to their children's pain management, understanding their perspectives on analgesics is essential. For caregivers of children with acute injury presenting to the pediatric emergency department (PED), we aimed to determine caregivers’: a) willingness to accept opioids from emergency care providers, b) reasons for refusing opioids, and c) past experiences with opioids. Methods: A novel 31-item electronic survey was offered, via tablet device, to caregivers of children aged 4-16 years who had a musculoskeletal injury <7 days old and presented to one of two Canadian PEDs between March and November 2017. Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results: 517 caregivers completed the survey; mean age was 40.9 +/−7 years with 70.0% (362/517) being mothers. Children included 62.2% (321/516) males with an overall mean age of 10 +/−3.6 years. 49.6% of caregivers (254/512) reported willingness to accept opioids for moderate pain that persisted after non-opioid analgesia, while 37.1% (190/512) were unsure what they would do. Only 33.2% (170/512) of caregivers stated they would accept opioid analgesia upon discharge while 45.5% (233/512) were unsure about at-home use. Caregivers were primarily concerned about side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (OR 1.12, 95% CI 1.01-1.25) and side effects (OR 1.25, 95% CI 1.11-1.42) increased the odds of rejecting opioids in the emergency department, while fears of addiction (OR 1.19, 95% CI 1.07-1.32) and overdose (OR 1.15, 95% CI 1.04-1.27) increased the odds of rejecting opioids for at-home use. Conclusion: Only half of caregivers reported that they would accept opioids for moderate pain, despite ongoing pain following non-opioid analgesics. Caregiver fears of addiction, side effects, overdose, and masking their child's diagnosis influence their behaviours. These findings are a first step in understanding caregiver decision-making and can guide healthcare providers in their conversations about acute pain treatment with families.
Collaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. We assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes, which are part of an integrated system.
This study included 63 VHA nursing homes enrolled in the “AHRQ Safety Program for Long-Term Care,” which focused on practices to reduce CAUTI.
Changes in CAUTI rates, catheter utilization, and urine culture orders were assessed from June 2015 through May 2016. Multilevel mixed-effects negative binomial regression was used to derive incidence rate ratios (IRRs) representing changes over the 12-month program period.
There was no significant change in CAUTI among VHA sites, with a CAUTI rate of 2.26 per 1,000 catheter days at month 1 and a rate of 3.19 at month 12 (incidence rate ratio [IRR], 0.99; 95% confidence interval [CI], 0.67–1.44). Results were similar for catheter utilization rates, which were 11.02% at month 1 and 11.30% at month 12 (IRR, 1.02; 95% CI, 0.95–1.09). The numbers of urine cultures per 1,000 residents were 5.27 in month 1 and 5.31 in month 12 (IRR, 0.93; 95% CI, 0.82–1.05).
No changes in CAUTI rates, catheter use, or urine culture orders were found during the program period. One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes. This low baseline rate is likely related to the VHA’s prior CAUTI prevention efforts. While broad-scale collaborative approaches may be effective in some settings, targeting higher-prevalence safety issues may be warranted at sites already engaged in extensive infection prevention efforts.
Introduction: Inadequate pain management in children is ubiquitous in the emergency department (ED). As the current national opioid crisis has highlighted, physicians are caught between balancing pain management and the risk of long term opioid dependence. This study aimed to describe pediatric emergency physicians (PEPs) willingness to prescribe opioids to children in the ED and at discharge. Methods: A unique survey tool was created using published methodology guidelines. Information regarding practices, knowledge, attitudes, perceived barriers, facilitators and demographics were collected. The survey was distributed to all physician members of Pediatric Emergency Research Canada (PERC), using a modified Dillmans Tailored Design method, from October to December 2017. Results: The response rate was 49.7% (124/242); 53% (57/107) were female, mean age was 43.6 years (+/− 8.7), and 58% (72/124) had pediatric emergency subspecialty training. The most common first line ED pain medication was ibuprofen for mild, moderate and severe musculoskeletal injury (MSK-I)-related pain (94.4% (117/124), 89.5% (111/124), and 62.9% (78/124), respectively). For moderate and severe MSK-I, intranasal fentanyl was the most common opioid for first (35.5% (44/124) and 61.3% (76/124), respectively) and second line pain management (41.1% (51/124) and 20.2% (25/124), respectively). 74.8% (89/119) of PEPs reported that an opioid protocol would be helpful, specifically for morphine, fentanyl, and hydromorphone. Using a 0-100 scale, physicians minimally worried about physical dependence (13.3 +/−19.3), addiction (16.6 +/−19.8), and diversion of opioids (32.8+/−26.4) when prescribing short-term opioids to children. They reported that the current opioid crisis minimally influenced their willingness to prescribe opioids (30.0 +/−26.2). Physicians reported rarely (36%; 45/125) or never (28%; 35/125) completing a screening risk assessment prior to prescribing opioids. Conclusion: Ibuprofen remains the most common medication recommended for MSK-I pain in the ED and at discharge. Intranasal fentanyl was the top opioid for all pain intensities. PEPs are minimally concerned regarding dependence, addiction, and the current opioid crisis when prescribing short-term opioids to children. There is an urgent need for robust evidence regarding the dependence and addiction risk for children receiving short term opioids in order to create knowledge translation tools for ED physicians. Opioid specific protocols for both in the ED and at discharge would likely improve physician comfort in responsible and adequate pain management for children.
On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with “mega-sheltering,” beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33–37)
Two aspects of the CAMDA group breeding scheme is to improve lamb growth rate and the mothering ability of Welsh Mountain sheep. Genetic variation for these traits is present (Aslaminejad et al., 1999) but the rate of genetic progress depends on the selection decisions made within the scheme. The objective of this study was to estimate the genetic gain achieved in the nucleus and members’ flocks over the 20 years since the scheme began.
A total of 31887 records of 12 and 18-week live weight of Welsh Mountain lambs collected between 1976 and 1995 in 7 flocks of the CAMDA scheme were used in this study. Each flock was analysed separately fitting a univariate animal model with a direct and maternal random genetic effect. Genetic parameters were estimated using a derivative-free restricted maximum likelihood algorithm (DFREML; Meyer, 1993).
The CAMDA group breeding scheme was established in 1976. Its objective is to increase lamb growth rate, mature size and maternal ability of the Welsh Mountain sheep while retaining their hardiness and breed type. The opportunity to achieve this goal depends on the extent of genetic variation within the breed for these traits. The objective of this study was to estimate the amount of variation in 18-week live weight attributable to the lamb genotype (direct) and dam maternal ability, both genetic and environmental, in Welsh Mountain sheep within this scheme.
A total of 12954 records of 18-week live weight of Welsh Mountain lambs collected between 1976 and 1995 from 4 flocks of the CAMDA scheme were considered. The data were edited for small contemporary groups and for incomplete performance or pedigree recording.
Commercial housing conditions are known to have an effect on the eating quality of bacon. Significant differences have been shown between pigs reared on solid concrete floors or straw-bedded accommodation (Maw et al. In press). Also high levels of dietary Vitamin E have been shown to improve pigmeat quality (Buckley et al., 1995). This experiment was carried out to examine whether the effects of housing could be eliminated or reversed by altering housing conditions or reduced by dietary supplementation with Vitamin E.
The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism Met allele exacerbates amyloid (Aβ) related decline in episodic memory (EM) and hippocampal volume (HV) over 36–54 months in preclinical Alzheimer's disease (AD). However, the extent to which Aβ+ and BDNF Val66Met is related to circulating markers of BDNF (e.g. serum) is unknown. We aimed to determine the effect of Aβ and the BDNF Val66Met polymorphism on levels of serum mBDNF, EM, and HV at baseline and over 18-months.
Non-demented older adults (n = 446) underwent Aβ neuroimaging and BDNF Val66Met genotyping. EM and HV were assessed at baseline and 18 months later. Fasted blood samples were obtained from each participant at baseline and at 18-month follow-up. Aβ PET neuroimaging was used to classify participants as Aβ– or Aβ+.
At baseline, Aβ+ adults showed worse EM impairment and lower serum mBDNF levels relative to Aβ- adults. BDNF Val66Met polymorphism did not affect serum mBDNF, EM, or HV at baseline. When considered over 18-months, compared to Aβ– Val homozygotes, Aβ+ Val homozygotes showed significant decline in EM and HV but not serum mBDNF. Similarly, compared to Aβ+ Val homozygotes, Aβ+ Met carriers showed significant decline in EM and HV over 18-months but showed no change in serum mBDNF.
While allelic variation in BDNF Val66Met may influence Aβ+ related neurodegeneration and memory loss over the short term, this is not related to serum mBDNF. Longer follow-up intervals may be required to further determine any relationships between serum mBDNF, EM, and HV in preclinical AD.
Salicylate plays an important role as a non-steroid, anti-inflammatory drug. In poultry, those used most commonly are sodium salicylate (SS) and acetylsalicylic acid (ASA), due to their immunomodulatory, analgesic, antipyretic, and anti-inflammatory activities. Other effects have been reported such as minimising the effects of heat stress, allostatic load, ascites, leg disorders, reducing respiratory and digestive disorders, as well as enhancing growth performance, feed utilisation, nutrient digestion and absorption, egg production and the quality of meat and eggs. Furthermore, ASA plays a key role in lowering cholesterol and triglycerides in blood, meat and eggs, and improvements in immune functions and antioxidant enzymes have been noted in birds. This paper reviews the different characteristics and beneficial applications of ASA in poultry nutrition for improving immunity, production, and safeguarding health, especially under heat stress conditions.
The Committee of the Corporation and Overseers will observe in the view that the Professor of Mathematics had for many years a larger salary than the Professor of Divinity…. Perhaps the discrimination continued too long.
An ice-surface temperature retrieval algorithm for the Greenland ice sheet was developed using NOAA 11 thermal radiances from channels 4 and 5. Temperature, pressure and humidity profiles, cloud observations and skin temperatures from the Swiss Federal Institute of Technology (ETH) camp, located at the equilibrium line altitude at 49°17′W, 69°34′N, were used in the LOWTRAN 7 model. Through a statistical analysis of daily clear sky profiles, the coefficients that correct for the atmospheric effects were determined for the ETH-Camp field season (May to August). Surface temperatures retrieved by this method were then compared against the in situ observations with a maximum difference of 0.6 K. The NOAA 11 narrow-band planetary albedo values for channels 1 and 2 were calculated using pre-launch calibration coefficients. Scattering and absorption by the atmosphere were modelled with LOWTRAN 7. Then, narrow-band albedo values for the AVHRR visible and near infrared channels were compared with in situ high resolution spectral reflectance measurements. In the visible band (580–680 nm), AVHRR-derived narrow-band albedo and the in situ measurements corrected with radiative transfer model LOWTRAN 7 showed a difference of less than 2%. For the near infrared channel (725–1100 nm) the difference between the measured and modelled narrow-band albedo was 14%. These discrepancies could be either the result of inaccurate aerosol scattering modelling (lack of the in situ observation), or the result of sensor drift due to degradation.
Having accurate data for ileal amino acid digestibility of a feed ingredient is one of the ways to enhance protein and nitrogen utilisation, improve poultry feeding efficiency, and mitigate ammonia emission and pollution in the environment. Moreover, the precise estimation of endogenous amino acid losses (EAAL) depends on formulating diets on digestible amino acid (DAA) basis. Numerous methods have been reported to determine the endogenous fractions including the regression method, the protein-free diet, and the total digestible nitrogen diet. The EAAL determined by these techniques can help in calculated corrected values for amino acid digestibility, termed true digestibility. Certain dietary components that can be called ‘specific losses’ could lead to higher losses than the basal calculation would indicate. To determine the basal plus specific losses (total endogenous losses), some researchers suggested the 15N-dilution method, which allows the determination of the actual digestibility. This method needs more studies and evaluations because there are some controversial issues about this methodology, such as the validity of the 15N-dilution technique when applied to any amino acid or to total nitrogen, the reference pool for the estimation of the labelling of endogenous fractions/secretions, anti-nutritional agents, the effect of bird age, mucin, different cereal grains, as well as the marker itself and the proper assessment. This review will be focused on the above issues, finding that the recently reported 15N isotopes single injection method could be an easy, time-saving, consistent, and reliable methodology for EAAL estimation in poultry.
Recession of the Laurentide Ice Sheet from northern New Hampshire was interrupted by the Littleton-Bethlehem (L-B) readvance and deposition of the extensive White Mountain Moraine System (WMMS). Our mapping of this moraine belt and related glacial lake sequence has refined the deglaciation history of the region. The age of the western part of the WMMS is constrained to ~14.0–13.8 cal ka BP by glacial Lake Hitchcock varves that occur beneath and above L-B readvance till and were matched to a revised calibration of the North American Varve Chronology presented here. Using this age for when boulders were deposited on the moraines has enabled calibration of regional cosmogenic-nuclide production rates to improve the precision of exposure dating in New England. The L-B readvance coincided with the Older Dryas (OD) cooling documented by workers in Europe and the equivalent GI-1d cooling event in the Greenland Ice Core Chronology 2005 (GICC05) time scale. The readvance and associated moraines provide the first well-documented and dated evidence of the OD event in the northeastern United States. Our lake sediment cores show that the Younger Dryas cooling was likewise prominent in the White Mountains, thus extending the record of this event westward from Maine and Maritime Canada.
In 14C dating of sediment, the date of deposition is associated with its C age. Most sediments are complex mixtures containing little organic material frequently derived from several sources. The most conspicuous sources of error result from 1) the incorporation of “fossil” carbon (eg, graphite, lignite, etc) into a more recent sediment. This is particularly important in low carbon sediments (Olsson, 1972); 2) the incorporation of older, ‘reworked’ sedimentary material, eg, from terrigenous sources into a lacustrine environment (Schoute, Mook & Streuerman, 1983); 3) the dating of mainly autochthonous material which has metabolized carbon from dissolved bicarbonate carbonates originating from dissolution of fossil.
To provide more information for the 14C ages of components of a sediment, we have used the small sample capability (ie, > = 1 mg carbon) of the Oxford Radiocarbon Accelerator to date specific fractions. Within the limitations of the ‘conventional’ method, different fractions in soils have been the subject of two investigations (Scharpenseel, 1979; Sheppard, Syed & Mehringer, 1979). In general the results show that a measurement on undifferentiated sediment may lead to serious errors in the 14C date, that specific fractions do not guarantee a better date for deposition, but nearly always provide valuable information on the particular history of the individual sediment in relation to its specific context. It is usually possible to estimate the occurrence of the first two sources of error listed above, but more difficult to quantify the extent of terrestrial input and “hard water” error.
A modified discussion of surface nuclear reactions in magnetic stars is given. The anomalous abundance effects found in magnetic stars are briefly described. It is suggested that the processes of particle acceleration are similar to those taking place in the solar atmosphere which give rise to the cosmic ray bursts observed by Wild, Roberts, and Murray, and to the solar component of cosmic radiation. Calculations of the rate of loss of energy following particle acceleration suggests that the duration of the hot spot is 1 ≲ sec. It is estimated that in the region of acceleration (p, n) reactions will enable a ratio nn/np ⋍ 10–2–10–3 to be built up. The majority of these neutrons will diffuse from the excited regions and form deuterium in the quiescent atmosphere. This deuterium will be continuously built up and re-acceleration will lead to the release of neutrons, some of which will be captured by the Fe group, eventually giving rise to the observed anomalous abundances of the heavy elements. Also the reaction H(d, γ) He3 may give rise to the formation of some He3.
Although the Great Basin of North America has produced some of the most robust and ancient fiber artifact assemblages in the world, many were recovered with poor chronological controls. Consequently, this class of artifacts has seldom been effectively incorporated into general discussions of early chronological and cultural patterns. In recent years, the Great Basin Textile Dating Project has accumulated direct AMS dates on textiles (bags, sandals, mats, cordage, and basketry) from dry caves in the Great Basin, particularly in the northern and western areas. We focus here on the terminal Pleistocene/early Holocene, to identify chronological patterns in this class of artifacts and to evaluate Adovasio’s characterization of the region’s earliest basketry as simple and undecorated. New AMS dates now suggest that the region’s earliest people had sophisticated textile traditions that incorporated numerous decorative elaborations. Some distinctive structures, including Fort Rock sandals and weft-faced plaited textiles, have limited early temporal ranges and may serve as diagnostic indicators for terminal Pleistocene/early Holocene times. Other basketry forms and structures that appear by about 9000 cal B.P. persist into the historic period, suggesting a stronger thread of continuity (especially in the north) from this time than is apparent in lithic traditions
The president calls attention to the large and increasing membership of Commission 12 and the policy of concentrating in it all matters relating to the sun. The result makes it comparable in breadth of field and in membership to the former Union for Co-operation in Solar Research. The main point in favour of this policy is the increased interest in the meetings of the Commission and the larger number of individuals reached compared with the meetings of small committees. One recalls the general sessions of the Solar Union in which each one present felt himself a part of the Union and in real touch with the work of different sections and after the discussions went away with fuller knowledge of what it was all about. This was a valuable result not attained to the same degree from the general sessions of the present Union, but in a measure it does follow from the meetings of the Solar Physics Committee. On the other hand the question may be raised whether or not the merging of independent commissions into subdivisions of a large commission lessens their interest to an extent not balanced by the advantages. If the present policy holds, it seems to the president that a re-organisation of Commission 12 is advisable by which more responsibility is laid upon the directors of centres. The basis of membership in the Commission may well be considered and recommendations formulated for transmission to the Executive Committee.
The 1932 report of this Commission, and the report of the ensuing discussion, revealed an unsatisfactory position with regard to sources of the red line of cadmium which could be relied upon to give the adopted standard value for the wave-length 6438.4696 x 10−10 metre.
Dr Meggers has summarised the position very clearly in a recent paper on “ Interference Measurements in the Spectra of Noble Gases” (B.S.J. Research, 13, 293, 1934) and has expressed a strong preference for the specification of the Michelson lamp adopted in 1927 by the International Conference of Weights and Measures (see Trans I.A.U. 4, 58, 1932). He points out that the I.A.U. specification of 1925 is less restricted, inasmuch as it does not exclude high-frequency excitation and makes no mention of the volume or capillary bore of the tube, but requires that it must give interferences with differences of path of at least 200,000 waves. The last condition is considered objectionable on the ground that this is less than half of the theoretical or actual limit of the Michelson tube, and it is further considered that cadmium sources in which any such reduction in interference order occurs will certainly yield a different value for the primary standard.