Neonatal procedural pain exposure and pain management in ventilated preterm infants during the first 14 days of life

OBJECTIVES: Ventilated preterm infants are at high risk for procedural pain exposure. In Switzerland there is a lack of knowledge about the pain management in this highly vulnerable patient population. The aims of this study were to describe the type and frequency of procedures and to determine the amount of analgesia given to this patient group in two Swiss neonatal intensive care units. METHOD: A retrospective cohort study was performed examining procedural exposure and pain management of a convenience sample of 120 ventilated preterm infants (mean age = 29.7 weeks of gestation) during the first 14 days of life after delivery and born between May 1st 2004 and March 31st 2006. RESULTS: The total number of procedures all the infants underwent was 38,626 indicating a mean of 22.9 general procedures performed per child and day. Overall, 75.6% of these procedures are considered to be painful. The most frequently performed procedure is manipulation on the CPAP prongs. Pain measurements were performed four to seven times per day. In all, 99.2% of the infants received either non-pharmacological and/or pharmacological agents and 70.8% received orally administered glucose as pre-emptive analgesia. Morphine was the most commonly used pharmacological agent. DISCUSSION: The number of procedures ventilated preterm infants are exposed to is disconcerting. Iatrogenic pain is a serious problem, particularly in preterm infants of low gestational age. The fact that nurses assessed pain on average four to seven times daily per infant indicates a commitment to exploring a painful state in a highly vulnerable patient population. In general, pharmacological pain management and the administration of oral glucose as a non-pharmacological pain relieving intervention appear to be adequate, but there may be deficiencies, particularly for extremely low birth weight infants born <28 weeks of gestation.

Interview and translation strategies: coping with multilingual settings and data

Central Eastern Europe, the research area this paper is concerned with, is a region characterized by a high diversity of languages and cultures. It is, at the same time, an area where political, cultural and social conflicts have emerged over time, nowadays especially in border zones, where people of different ethnic, cultural or linguistic background live. In this context, it is important for us researchers to get balanced interview data, and consequently we very often have to conduct interviews in several different languages and within changing cultural contexts. In order to avoid "communication problems" or even conflictual (interview) situations, which might damage the outcome of the research, we are thus challenged to find appropriate communication strategies for any of these situations. This is especially difficult when we are confronted with language or culture-specific terminology or taboo expressions that carry political meaning(s). Once the interview data is collected and it comes to translating and analysing it, we face further challenges and new questions arise. First of all, we have to decide what a good translation strategy would be. Many words and phrases that exist in one language do not have an exact equivalent in another. Therefore we have to find a solution for translating these expressions and concepts in a way that their meanings do not get "lost by translation". In this paper I discuss and provide insights to these challenges by presenting and discussing numerous examples from the region in question. Specifically, I focus on the deconstruction of the meaning of geographical names and politically loaded expressions in order to show the sensitivities of language, the difficulties of research in multilingual settings and with multilingual data as well as the strategies or "ways out" of certain dilemmas.

United we stand, divided we fall: a meta-analysis of experiments on clonal integration and its relationship to invasiveness

Fragmentation and vegetative regeneration from small fragments may contribute to population expansion, dispersal and establishment of new populations of introduced plants. However, no study has systematically tested whether a high capacity of vegetative regeneration is associated with a high degree of invasiveness. For small single-node fragments, the presence of internodes may increase regeneration capacity because internodes may store carbohydrates and proteins that can be used for regeneration. We conducted an experiment with 39 stoloniferous plant species to examine the regeneration capacity of small, single-node fragments with or without attached stolon internodes. We asked (1) whether the presence of stolon internodes increases regeneration from single-node fragments, (2) whether regeneration capacity differs between native and introduced species in China, and (3) whether regeneration capacity is positively associated with plant invasiveness at a regional scale (within China) and at a global scale. Most species could regenerate from single-node fragments, and the presence of internodes increased regeneration rate and subsequent growth and/or asexual reproduction. Regeneration capacity varied greatly among species, but showed no relationship to invasiveness, either in China or globally. High regeneration capacity from small fragments may contribute to performance of clonal plants in general, but it does not appear to explain differences in invasiveness among stoloniferous clonal species.

Anesthetic and Airways Management of a Dog with Severe Tracheal Collapse during Intraluminal Stent Placement

This case report describes the anesthetic and airways management of a dog affected by 4th degree tracheal collapse and undergoing endoscope-guided intraluminal stent placement. After premedication with acepromazine and butorphanol, general anesthesia was induced with propofol and maintained with intravenous propofol and butorphanol in constant rate infusion. During intraluminal stent placement, oxygen was supplemented by means of a simple and inexpensive handmade device, namely, a ureteral catheter inserted into the trachea and connected to an oxygen source, which allowed for the maintenance of airways’ patency and adequate patient’s oxygenation, without decreasing visibility in the surgical field or interfering with the procedure. The use of the technique described in the present paper was the main determinant of the successful anesthetic management and may be proposed for similar critical cases in which surgical manipulation of the tracheal lumen, which may potentially result in hypoxia by compromising airways patency, is required.

Proposal for an International Molybdenum Isotope Measurement Standard and Data Representation

Molybdenum isotopes are increasingly widely applied in Earth Sciences. They are primarily used to investigate the oxygenation of Earth's ocean and atmosphere. However, more and more fields of application are being developed, such as magmatic and hydrothermal processes, planetary sciences or the tracking of environmental pollution. Here, we present a proposal for a unifying presentation of Mo isotope ratios in the studies of mass-dependent isotope fractionation. We suggest that the δ98/95Mo of the NIST SRM 3134 be defined as +0.25‰. The rationale is that the vast majority of published data are presented relative to reference materials that are similar, but not identical, and that are all slightly lighter than NIST SRM 3134. Our proposed data presentation allows a direct first-order comparison of almost all old data with future work while referring to an international measurement standard. In particular, canonical δ98/95Mo values such as +2.3‰ for seawater and −0.7‰ for marine Fe–Mn precipitates can be kept for discussion. As recent publications show that the ocean molybdenum isotope signature is homogeneous, the IAPSO ocean water standard or any other open ocean water sample is suggested as a secondary measurement standard, with a defined δ98/95Mo value of +2.34 ± 0.10‰ (2s). Les isotopes du molybdène (Mo) sont de plus en plus largement utilisés dans les sciences de la Terre. Ils sont principalement utilisés pour étudier l'oxygénation de l'océan et de l'atmosphère de la Terre. Cependant, de plus en plus de domaines d'application sont en cours de développement, tels que ceux concernant les processus magmatiques et hydrothermaux, les sciences planétaires ou encore le suivi de la pollution environnementale. Ici, nous présentons une proposition de présentation unifiée des rapports isotopiques du Mo dans les études du fractionnement isotopique dépendant de la masse. Nous suggérons que le δ98/95Mo du NIST SRM 3134 soit définit comme étant égal à +0.25 ‰. La raison est que la grande majorité des données publiées sont présentés par rapport à des matériaux de référence qui sont similaires, mais pas identiques, et qui sont tous légèrement plus léger que le NIST SRM 3134. Notre proposition de présentation des données permet une comparaison directe au premier ordre de presque toutes les anciennes données avec les travaux futurs en se référant à un standard international. En particulier, les valeurs canoniques du δ98/95Mo comme celle de +2,3 ‰ pour l'eau de mer et de -0,7 ‰ pour les précipités de Fe-Mn marins peuvent être conservés pour la discussion. Comme les publications récentes montrent que la signature isotopique moyenne du molybdène de l'océan est homogène, le standard de l'eau océanique IAPSO ou tout autre échantillon d'eau provenant de l'océan ouvert sont proposé comme standards secondaires, avec une valeur définie du δ98/95 Mo de 2.34 ± 0.10 ‰ (2s).

Fuzzy Web Knowledge Aggregation, Representation, and Reasoning for Online Privacy and Reputation Management

A social Semantic Web empowers its users to have access to collective Web knowledge in a simple manner, and for that reason, controlling online privacy and reputation becomes increasingly important, and must be taken seriously. This chapter presents Fuzzy Cognitive Maps (FCM) as a vehicle for Web knowledge aggregation, representation, and reasoning. With this in mind, a conceptual framework for Web knowledge aggregation, representation, and reasoning is introduced along with a use case, in which the importance of investigative searching for online privacy and reputation is highlighted. Thereby it is demonstrated how a user can establish a positive online presence.

Bullous pemphigoid: therapeutic algrorithm and practical management

Introduction: Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease of the skin and mucosae. BP typically affects the elderly and manifests with severe itch, localised or generalised eczematous, urticated and/or bullous lesions. Its morbidity and impact on the quality of life are important. The disease is significantly associated with neurological disorders, such as stroke, Parkinson disease, major cognitive impairment and multiple sclerosis. Diagnosis of BP critically relies on immunopathologic examinations, particularly direct immunofluorescence microscopy studies. Areas covered: This paper looks at the evidence of therapies commonly used in bullous pemphigoid. Expert opinion: Treatment of BP has been a challenge, given the relative rarity of the disease, lack of good quality randomised controlled trials, the presence of co-morbidities in the affected elderly population and the high mortality rate. Recent controlled studies have indicated that potent topical corticosteroids constitute a more effective therapy for BP when compared to oral corticosteroids in terms of control of the disease, side effect profile and overall survival. Other therapies have been employed with varying success, but are not validated yet. Improved knowledge of the pathophysiology of BP will hopefully allow the development of new immunomodulatory treatments for this debilitating disease.

Internet-based exercises and mini-exams for production and operations management

The purpose of the internet-based teachware mySCM is that students of economics, informatics and industrial engineering get familiar with quantitative methods for supply chain management. Input-output-relationships of various optimization methods can be detected by sampling input values, parameters, and alternative methods for the same problem. Students can gain extra benefits by passing so-called mini-exams that motivate active learning. mySCM can be used for free, round-the-clock, and any place where access to the Internet is available.