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On October 10, 2020, the Memorial Sloan Kettering Cancer Center Supportive Care Service hosted their first-ever United States (US) World Hospice and Palliative Care Day (WHPCD) Celebration. The purpose of this article is to describe the US inaugural event in alignment with the broader goals of WHPCD and provide lessons learned in anticipation of the second annual conference to be held on October 5–6, 2021.
Description of the inaugural event in the context of COVID-19 and WHPCD, co-planning conference team reflection, and attendee survey responses.
The Worldwide Hospice Palliative Care Alliance initially launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care around the world. The US-based innovative virtual conference featured 23 interprofessional hospice and palliative care specialists and patient and family caregiver speakers across nine diverse sessions addressing priorities at the intersection of COVID-19, social injustice, and the global burden of serious health-related suffering. Two primary aims guided the event: community building and wisdom sharing. Nearly 270 registrants from at least 16 countries and one dozen states across the US joined the free program focused on both personal and professional development.
Significance of results
Unlike many other academic conferences and professional gatherings that were relegated to online forums due to pandemic-related restrictions, the US WHPCD Celebration was intentionally established to create a virtual coming together for collective reflection on the barriers and facilitators of palliative care delivery amid vast societal change. The goal to ensure a globally relevant and culturally inclusive agenda will continue to draw increased participation at an international level during future annual events. Finally, the transparent and respectful sharing of palliative care team experiences in the year preceding the conference established a safe environment for both individual expression and scholarly discussion.
Hairy buttercup and cutleaf evening primrose are winter annual weeds that have become more problematic for winter wheat growers in the southern Great Plains and the midsouthern United States in recent years. Little research exists on which to base recommendations for controlling hairy buttercup in wheat, and little research has been published on cutleaf evening primrose control in recent years. With growing concerns of increased herbicide resistance among winter annual weeds, incorporating new herbicide sites of action has become necessary. The objective of this study was to assess halauxifen-methyl as a novel herbicide to control these two problematic winter annual broadleaf weeds in winter wheat in Mississippi and Oklahoma. Studies were conducted across four site-years in Mississippi and one site-year in Oklahoma comparing 15 herbicide programs with and without halauxifen-methyl. Hairy buttercup and cutleaf evening-primrose control was the greatest when a synthetic auxin was combined with an acetolactate synthase–inhibiting herbicide. Treatments including halauxifen-methyl resulted in the greatest control of hairy buttercup, whereas a synthetic auxin herbicide plus chlorsulfuron and metsulfuron resulted in the greatest control of cutleaf evening primrose. Halauxifen-methyl is an effective addition for control of winter annual broadleaf weeds like hairy buttercup and cutleaf evening primrose in winter wheat.
A 54-year-old woman prepares dinner around 8:00 pm that includes mushrooms that she picked from her yard. The next morning, around 8:00 am, the woman (patient), her daughter, and son-in-law all develop abdominal cramps, violent vomiting, and diarrhea. They present to the emergency department and are admitted for dehydration and intractable vomiting with a presumed diagnosis of food poisoning. Twenty-four hours later, they appear well with stable vital signs and improved symptoms. Four hours later, 36 hours post-ingestion, the patient becomes lethargic. A venous blood gas reveals pH, 7.1; PCO2, 16 mmHg; and her AST was 3140 units/L with an ALT of 4260 units/L and an INR of 3.7.
Recent developments in magnetic resonance imaging have enabled demonstration of endolymphatic hydrops, and the clinical application of these imaging studies in Ménière's disease is being explored.
To evaluate our centre's experience to date of hydrops magnetic resonance imaging in patients with episodic vertigo.
Magnetic resonance imaging was performed using a high-resolution three-dimensional fluid-attenuated inversion recovery sequence on a 3 Tesla scanner at 4 hours following double-dose gadolinium administration.
The study included 31 patients, 28 of whom had a clinical diagnosis of Ménière's disease. In unilateral Ménière's disease, magnetic resonance imaging was able to lateralise endolymphatic hydrops to the clinically symptomatic ear in all cases. Mild hydrops was often seen in clinically asymptomatic ears.
There is a good correlation between the clinical symptoms and lateralisation of hydropic changes on magnetic resonance imaging. Further refinements of imaging techniques and grading system will likely improve the diagnostic accuracy and clinical utilisation of hydrops magnetic resonance imaging.
Impulsive aggressive (IA, or impulsive aggression) behavior describes an aggregate set of maladaptive, aggressive behaviors occurring across multiple neuropsychiatric disorders. IA is reactive, eruptive, sudden, and unplanned; it provides information about the severity, but not the nature, of its associated primary disorder. IA in children and adolescents is of serious clinical concern for patients, families, and physicians, given the detrimental impact pediatric IA can have on development. Currently, the ability to properly identify, monitor, and treat IA behavior across clinical populations is hindered by two major roadblocks: (1) the lack of an assessment tool designed for and sensitive to the set of behaviors comprising IA, and (2) the absence of a treatment indicated for IA symptomatology. In this review, we discuss the clinical gaps in the approach to monitoring and treating IA behavior, and highlight emerging solutions that may improve clinical outcomes in patients with IA.
Previous research suggests that adult anxiety disorders begin in adolescence and the transition from primary school to secondary school is the first challenge many young adolescents face, which could test their resilience for the first time.
To examine students’ anxiety scores before and after their transition, and what protective and risk factors are present during this challenge.
To determine how the transition can impact anxiety in children, and if protective factors can help decrease the disruption that the transition can cause.
One hundred and eighty-four pupils completed questionnaires in their last term of primary school and during the first term of secondary school. At time 1: the attachment, school membership, and bullying and victimization measures were compared with pupils’ anxiety scores, along with whether their friends or siblings will be attending the same secondary school as them. These analyses will also be conducted once the pupils start secondary school, at time 2.
Secure attachment was associated with lower anxiety and transition anxiety (F(2.56) = 7.255, P = .002; F(2.52) = 19.245, P = .000; F(2.181) = 10.181, P = .000; F(2.53) = 20.545, P = .000). School membership was associated with lower transition anxiety (F(2.181) = 4.151, P = .017; F(2.181) = 3.632, P = .028). Low victimisation was also associated with low anxiety and transition anxiety (F(2.181) = 14.024, P = .000; F(2.181) = 14.529, P = .000; F(2.181) = 9.381, P = .000).
These preliminary results suggest that attachment, school membership and victimisation all impact on pupils anxiety before they transition to secondary school. Therefore, schools could work together to increase school membership and decrease victimisation, particularly for pupils who they suspect will struggle with the transition.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Family dysfunction can test the resilience of adolescents, specifically those from single parent families and those attending schools in more socio-economically challenged areas.
To determine what factors are associated with resilience for those from single parent families or attend schools in more socio-economically challenged areas.
To examine the role of emotional regulation and self-esteem as putative resilience factors in the context of single parents status and socioeconomic disadvantage.
Secondary school pupils from single and dual parent families aged 13 to 15 answered questionnaires at three time points on: emotional regulation, self-esteem, depression and anxiety. A total of 434 pupils took part at time 1, 574 at time 2, and 467 at time 3. The secondary schools were categorised into more and less disadvantaged schools.
Positive self-esteem [F(1.205) = 54.568, P = 0.000; F(1.157) = 35.582, P = 0.000] and emotional regulation [F(1.205) = 46.925, P = 0.000; F(1.157) = 16.583, P = 0.000] were both associated with resilience against depression in adolescents from single parent families. Positive self-esteem [F(1,75) = 102.629, P = 0.000; F(1.355) = 60.555, P = 0.000] and emotional regulation [F(1.60) = 34.813, P = 0.000; F(1.73) = 36.891, P = 0.000] were both associated with resilience against depression in adolescents attending more socio-economically challenged areas.
This research suggests that adolescent resilience against depression may be promoted by improving self-esteem and emotional regulation. Therefore, future interventions could focus on boosting these resilience factors. Further resilience research could include emotional regulation and self-esteem as protective factors for resilience in adolescent mental health. As these variables have been identified, they can help find more pieces to the complex puzzle of resilience.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Square Kilometre Array (SKA) is a planned large radio interferometer designed to operate over a wide range of frequencies, and with an order of magnitude greater sensitivity and survey speed than any current radio telescope. The SKA will address many important topics in astronomy, ranging from planet formation to distant galaxies. However, in this work, we consider the perspective of the SKA as a facility for studying physics. We review four areas in which the SKA is expected to make major contributions to our understanding of fundamental physics: cosmic dawn and reionisation; gravity and gravitational radiation; cosmology and dark energy; and dark matter and astroparticle physics. These discussions demonstrate that the SKA will be a spectacular physics machine, which will provide many new breakthroughs and novel insights on matter, energy, and spacetime.
Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.
In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.
There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.
High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.
Chloris spp. are warm-season grasses that outcompete crops for scarce resources throughout Australia. In Queensland, mild winters and increased adoption of conservation tillage practices have led to an increase of this warm-season grass family in winter crops. The objective of this study is to understand whether droplet size (nozzle type) effects herbicide efficacy of summer perennial grasses, as previous research found no effect of droplet size (nozzle type) on herbicide efficacy of winter annual grasses. A study to compare droplet-size (nozzle type) effects on control of windmillgrass and its domesticated relative, rhodesgrass, was conducted at the University of Queensland in Gatton, QLD, Australia. Results showed little difference in dry weight reductions for windmillgrass or rhodesgrass across droplet size (nozzle type). Paraquat applications with the TTI nozzle resulted in significantly lower dry weight reductions compared with other droplet-size sprays (nozzle types) for rhodesgrass. Glyphosate, imazamox plus imazapyr, and clodinafop resulted in commercially acceptable control for both species, regardless of the droplet size (nozzle type) selected, indicating droplet size (nozzle type) has relatively little impact on the efficacy of these herbicides. Proper nozzle selection can result in control of Chloris spp., a hard to control weed species, while reducing the occurrence of spray drift to nearby sensitive areas.
This case report illustrates an unusual case of a dural arteriovenous fistula and an associated encephalocele presenting as otitis media with effusion.
A 53-year-old man presented with right-sided hearing loss and aural fullness of 2 years’ duration. Examination revealed ipsilateral post-auricular pulsatile tenderness. Computed tomography showed transcalvarial channels suggestive of dural arteriovenous fistula. Further magnetic resonance imaging demonstrated the presence of a temporal encephalocele herniating through the tegmen tympani defect, as well as the abnormal vascularity. Angiography confirmed a Cognard type I dural arteriovenous fistula, which is being managed conservatively. Surgical repair of the encephalocele was recommended but declined by the patient.
Dural arteriovenous fistula is an uncommon intracranial vascular malformation rarely seen by otolaryngologists, with pulsatile tinnitus being the usual presentation. To our knowledge, this is the first reported case of dural arteriovenous fistula presenting with conductive hearing loss and otalgia.
Introduction: Recent reports suggest that up to 30% of medical interventions provide no benefit to patients. In a response to ED over-crowding, guidelines commonly exist to guide blood test ordering in patients waiting to see a physician. In many cases, this increases the use of tests without benefiting patients. We describe a quality improvement project designed to reduce the number of laboratory tests considered routine for waiting patients. Methods: A multidisciplinary group reviewed existing symptom-prompted nursing blood test guidelines for serum electrolytes and glucose, renal function tests, liver tests, lipase, toxicological tests and beta Human Chorionic gonadotrophin levels. Order sets were revised with tests eliminated from the routine panels that were not felt to routinely contribute to patient care. The new guidelines were communicated to nursing staff in a series of educational sessions, and the revised guidelines were posted at nursing stations. Physician ordering practice was not changed. A pre-post evaluation compared the period 1 December 2014, - 30 November 2015 with 1 December 2015 - 30 November 2016. Clinical outcomes and patient wait times were not evaluated. Results: The use of tests in these categories decreased 32% between the two periods, at a net saving of $210, 246c. The largest savings came from total protein (73% decrease), Creatine kinase (68%), chloride (64%), glucose (49%), and albumin (47%). Sodium/Potassium testing decreased by only 13%. The only increase in test ordering recorded was AST (3% increase). Conclusion: Simply changing symptom driven order sets resulted in significant savings to the system. In the era of Choosing wisely regular review of lab order sets is indicated. Further study is needed to assess the effect of these changes on patient flow and on clinical outcome.
Pressure ridges impact the mass, energy and momentum budgets of the sea-ice cover and present an obstacle to transportation through ice-infested waters. Quantifying ridge characteristics is important for understanding total sea-ice mass and for improving the representation of sea-ice dynamics in high-resolution models. Multi-sensor measurements collected during annual Operation IceBridge (OIB) airborne surveys of the Arctic provide new opportunities to assess the sea ice at the end of winter. We present a new methodology to derive ridge sail height from high-resolution OIB Digital Mapping System (DMS) visible imagery. We assess the efficacy of the methodology by mapping the full sail height distribution along 12 pressure ridges in the western and central Arctic. Comparisons against coincident Airborne Topographic Mapper (ATM) elevation anomalies are used to demonstrate the methodology and evaluate DMS-derived sail heights. Sail heights and elevation anomalies were correlated at 0.81 or above. On average mean and maximum sail height agreed with ATM elevation to within 0.11 and 0.49 m, respectively. Of the ridges mapped, mean sail height ranged from 0.99 to 2.16 m, while maximum sail height ranged from 2.1 to 4.8 m. DMS also delivered higher sampling along ridge crests than coincident ATM data.
Despite the early optical detection of the Crab pulsar in 1969, optical pulsars have become the poor cousin of the neutron star family. Only five normal pulsars have been observed to pulse in the optical waveband. A further three magnetars/SGRs have been detected in the optical/near IR. Optical pulsars are intrinsically faint with a first order luminosity, predicted by Pacini, to be proportional to P−10, where P is the pulsar’s period. Consequently they require both large telescopes, generally over-subscribed, and long exposure times, generally difficult to get. However optical observations have the benefit that polarisation and spectral observations are possible compared to X-ray and gamma-ray observations where polarisation measurements are limited. Over the next decade the number of optical pulsars should increase as optical detectors approach 100% quantum efficiency and as we move into the era of extremely large telescopes where limiting fluxes will be 30 to 100 times fainter compared to existing optical telescopes.
In this paper we describe a perfect simulation algorithm for the stable M/G/c queue. Sigman (2011) showed how to build a dominated coupling-from-the-past algorithm for perfect simulation of the super-stable M/G/c queue operating under first-come-first-served discipline. Sigman's method used a dominating process provided by the corresponding M/G/1 queue (using Wolff's sample path monotonicity, which applies when service durations are coupled in order of initiation of service). The method exploited the fact that the workload process for the M/G/1 queue remains the same under different queueing disciplines, in particular under the processor sharing discipline, for which a dynamic reversibility property holds. We generalise Sigman's construction to the stable case by comparing the M/G/c queue to a copy run under random assignment. This allows us to produce a naïve perfect simulation algorithm based on running the dominating process back to the time it first empties. We also construct a more efficient algorithm that uses sandwiching by lower and upper processes constructed as coupled M/G/c queues started respectively from the empty state and the state of the M/G/c queue under random assignment. A careful analysis shows that appropriate ordering relationships can still be maintained, so long as service durations continue to be coupled in order of initiation of service. We summarise statistical checks of simulation output, and demonstrate that the mean run-time is finite so long as the second moment of the service duration distribution is finite.
Auditory implantation into the inner ear is increasingly performed for a variety of indications. Infective complications are rare, but when they occur they can have devastating consequences.
This paper reports two cases where vestibular sequestration of the bony labyrinth developed following implantation into the middle ear.
To the authors' knowledge, these are the first reported cases where vestibular sequestration has resulted from auditory implant surgery. This paper outlines the radiological changes characteristic of this pathology. It also describes the surgical and conservative treatment options for this condition, challenging the previously accepted belief that affected patients always require aggressive surgical intervention.