Bedside application of the Neonatal Facial Coding System in pain assessment of premature neonates

Assessment of infant pain is a pressing concern, especially within the context of neonatal intensive care where infants may be exposed to prolonged and repeated pain during lengthy hospitalization. In the present study the feasibility of carrying out the complete Neonatal Facial Coding System (NFCS) in real time at bedside, specifically reliability, construct and concurrent validity, was evaluated in a tertiary level Neonatal Intensive Care Unit (NICU). Heel lance was used as a model of procedural pain, and observed with n = 40 infants at 32 weeks gestational age. Infant sleep/wake state, NFCS facial activity and specific hand movements were coded during baseline, unwrap, swab, heel lance, squeezing and recovery events. Heart rate was recorded continuously and digitally sampled using a custom designed computer system. Repeated measures analysis of variance (ANOVA) showed statistically significant differences across events for facial activity (P <0.0001) and heart rate (P <0.0001). Planned comparisons showed facial activity unchanged during baseline, swab and unwrap, then increased significantly during heel lance (P <0.0001), increased further during squeezing (P <0.003), then decreased during recovery (P <0.0001). Systematic shifts in sleep/wake state were apparent. Rise in facial activity was consistent with increased heart rate, except that facial activity more closely paralleled initiation of the invasive event. Thus facial display was more specific to tissue damage compared with heart rate. Inter-observer reliability was high. Construct validity of the NFCS at bedside was demonstrated as invasive procedures were distinguished from tactile. While bedside coding of behavior does not permit raters to be blind to events, mechanical recording of heart rate allowed for an independent source of concurrent validation for bedside application of the NFCS scale.

What is an absolute right? Deciphering absoluteness in the context of Article 3 of the European Convention on Human Rights

The answer to the question of what it means to say that a right is absolute is often taken for granted, yet still sparks doubt and scepticism. This article investigates absoluteness further, bringing rights theory and the judicial approach on an absolute right together. A theoretical framework is set up that addresses two distinct but potentially related parameters of investigation: the first is what I have labelled the ‘applicability’ criterion, which looks at whether and when the applicability of the standard referred to as absolute can be displaced, in other words whether other considerations can justify its infringement; the second parameter, which I have labelled the ‘specification’ criterion, explores the degree to which and bases on which the content of the standard characterised as absolute is specified. This theoretical framework is then used to assess key principles and issues that arise in the Strasbourg Court’s approach to Article 3. It is suggested that this analysis allows us to explore both the distinction and the interplay between the two parameters in the judicial interpretation of the right and that appreciating the significance of this is fundamental to the understanding of and discourse on the concept of an absolute right.

Whole-Vehicle modelling of exhaust energy recovery on a diesel-electric hybrid bus

Hybrid vehicles can use energy storage systems to disconnect the engine from the driving wheels of the vehicle. This enables the engine to be run closer to its optimum operating condition, but fuel energy is still wasted through the exhaust system as heat. The use of a turbogenerator on the exhaust line addresses this problem by capturing some of the otherwise wasted heat and converting it into useful electrical energy.

This paper outlines the work undertaken to model the engine of a diesel-electric hybrid bus, coupled with a hybrid powertrain model which analysed the performance of a hybrid vehicle over a drive-cycle. The distribution of the turbogenerator power was analysed along with the effect on the fuel consumption of the bus. This showed that including the turbogenerator produced a 2.4% reduction in fuel consumption over a typical drive-cycle.

The hybrid bus generator was then optimised to improve the performance of the combined vehicle/engine package and the turbogenerator was then shown to offer a 3.0% reduction in fuel consumption. The financial benefits of using the turbogenerator were also considered in terms of fuel savings for operators. For an average bus, a turbogenerator could reduce fuel costs by around £1200 per year.

Advocacy in pain management: the role of the anaesthetic nurse specialist

Peri-operative nursing practice is constantly changing and demanding specialist knowledge, skills and expertise to embrace these changes. All patients in need of anaesthesia are entitled to the same high quality peri-operative care and therefore those assisting the anaesthetist must be competent and effective practitioners. With this in mind the authors shall give a reflective account highlighting the role of Anaesthetic Nurse Specialist (ANS) in promoting leadership within the peri-operative environment and how it can be nurtured and facilitated to achieve professional autonomy and promote patient advocacy.

Fragmentos de Soto de Rojas: a ‘new’ mythological fable of the Spanish Baroque

The twentieth-century poet Gerardo Diego’s commitment to the recovery of a ‘sub-genre’, the mythological fable, evident in his Fábula de Equis y Zeda (1930) has been acknowledged by Peinado Elliot (2006), among others. However a recent discovery in his archive has revealed a hitherto unknown aspect of the poet’s scholarly commitment to this endeavour. A transcription of a previously unpublished, and until recently, unknown Baroque mythological fable with the title ‘Fábula de Alfeo y Aretusa’ was recently found by his daughter Elena, alongside an unpublished study by the young poet of said fable entitled ‘Un poema manuscrito del siglo XVII de la biblioteca Menéndez Pelayo’. Rosa Navarro Durán (2012) is convinced that the correspondences with Soto de Rojas’ 'Los fragmentos de Adonis' and the clear imprint of Góngora’s 'Soledades' and his 'Fábula de Píramo y Tisbe' permit us to attribute it, with some confidence, to Pedro Soto de Rojas. This essay will consider the significance of this exciting discovery for our reading of Soto de Rojas’ existing corpus, exploring in particular the poem’s links with the dark eroticism of the Fragmentos de Adonis, (1652) and the early Fábula de la Naya.(1623)

Characterizing changes in the excitability of corticospinal projections to proximal muscles of the upper limb

Background: There has been an explosion of interest in methods of exogenous brain stimulation that induce changes in the excitability of human cerebral cortex. The expectation is that these methods may promote recovery of function following brain injury. To assess their effects on motor output, it is typical to assess the state of corticospinal projections from primary motor cortex to muscles of the hand, via electromyographic responses to transcranial magnetic stimulation. If a range of stimulation intensities is employed, the recruitment curves (RCs) obtained can, at least for intrinsic hand muscles, be fitted by a sigmoid function.

Objective/hypothesis: To establish whether sigmoid fits provide a reliable basis upon which to characterize the input–output properties of the corticospinal pathway for muscles proximal to the hand, and to assess as an alternative the area under the (recruitment) curve (AURC).

Methods: A comparison of the reliability of these measures, using RCs obtained for muscles that are frequently the targets of rehabilitation.

Results: The AURC is an extremely reliable measure of the state of corticospinal projections to hand and forearm muscles, which has both face and concurrent validity. Construct validity is demonstrated by detection of widely distributed (across muscles) changes in corticospinal excitability induced by paired associative stimulation (PAS).

Conclusion(s): The parameters derived from sigmoid fits are unlikely to provide an adequate means to assess the effectiveness of therapeutic regimes. The AURC can be employed to characterize corticospinal projections to a range of muscles, and gauge the efficacy of longitudinal interventions in clinical rehabilitation.

Use of the γ-H2AX Assay to Investigate DNA Repair Dynamics Following Multiple Radiation Exposures

Radiation therapy is one of the most common and effective strategies used to treat cancer. The irradiation is usually performed with a fractionated scheme, where the dose required to kill tumour cells is given in several sessions, spaced by specific time intervals, to allow healthy tissue recovery. In this work, we examined the DNA repair dynamics of cells exposed to radiation delivered in fractions, by assessing the response of histone-2AX (H2AX) phosphorylation (γ-H2AX), a marker of DNA double strand breaks. γ-H2AX foci induction and disappearance were monitored following split dose irradiation experiments in which time interval between exposure and dose were varied. Experimental data have been coupled to an analytical theoretical model, in order to quantify key parameters involved in the foci induction process. Induction of γ-H2AX foci was found to be affected by the initial radiation exposure with a smaller number of foci induced by subsequent exposures. This was compared to chromatin relaxation and cell survival. The time needed for full recovery of γ-H2AX foci induction was quantified (12 hours) and the 1:1 relationship between radiation induced DNA double strand breaks and foci numbers was critically assessed in the multiple irradiation scenarios.

Victimhood and Attitudes towards Dealing with the Legacy of the Past: Northern Ireland as a Case Study

Research Highlights and Abstract: Using Northern Ireland as a case study, this article provides the first nationally representative and systematic study of victims' views on how to deal with the past; Focusing specifically on Northern Ireland, it both investigates and provides a comprehensive account of the marked divisions between the various religious groupings-Protestants, Catholics and the non-affiliated-in terms of a range of truth recovery mechanisms to deal with legacy of its violent past; It empirically investigates and validates two key predictors-perceptions of victimhood and general attitudes towards the past-in determining the source of these divisions It outlines the implications of our findings for other societies emerging from conflict. Truth recovery mechanisms have become a cornerstone of peacebuilding efforts in societies emerging from conflict. Yet, to date, the view of victims in post-conflict societies concerning such arrangements remains highly anecdotal and often second-hand in nature. Mindful of this omission and using Northern Ireland as a case study, this article investigates the views of victims towards a range of mechanisms to deal with the legacy of Northern Ireland's violent past. Based on the 2011 Northern Ireland Social and Political Attitudes Survey, the results suggest some marked divisions in relation to this issue, with victims within the Catholic community being significantly more supportive of such initiatives than either Protestants or those with no religion. Moreover, while perceptions of victimhood emerge as the key predictor of attitudes among Protestants and the non-affiliated, general opinions on how to deal with the past are the key determinant of views among members of the Catholic community

I can hear once more: The role of the Anaesthetic Nurse specialist in Cochlear implantation for people with long term deafness

This paper examines the role of the Anaesthetic Nuse Specialist(ANS) in the context of innovative cochlear implant surgery which restores hearing to those with long term deafness. The specific focus is patient centered care during the long surgery under local anaestha when the patient is awake.
It is crucial during this surgery that the patient remains still, relaxed and calm, the ANS has been particularly creative using communication cards and tablets to allow patients to write questions and the nurse to answer. The writers capture the unique moment when someone with long term hearing can hear, and the ensuing emotion from the patient and theatre team.

Metaphor and Matter(s) Arising: Gongorine Metaphor and the Cultivation of the Imagination

This article focuses on the concept of metaphor as metaphorai, as varied means of transfer and transport, specifically on Góngora's innovative development of the metaphor as a vehicle for experiential transformation and epistemological exploration; ultimately emphasizing a hitherto neglected valorization of affect in the liberation of the imagination. Although Góngora's use of metaphor became a major source of controversy in the debate unleashed by the Polifemo and Soledades during his lifetime, the Generation of 1927 looked to Gongorine metaphor as model and inspiration for their cultivation of imaginary worlds through poetry. By examining the models and concepts that nourished Góngora's innovative engagement with metaphor, shaped readers' responses to the poet's imaginary worlds of metaphor, triggered the recovery and reframing of Gongorine metaphor as springboard for the poetic imagination in the twentieth century, and sheds light on the power of Góngora's metaphor to transform and transmute the world through the exercise of the imagination.

Winter Is Coming: Seasonal Variation in Resting Metabolic Rate of the European Badger (Meles meles)

Resting metabolic rate (RMR) is a measure of the minimum energy requirements of an animal at rest, and can give an indication of the costs of somatic maintenance. We measured RMR of free-ranging European badgers (Meles meles) to determine whether differences were related to sex, age and season. Badgers were captured in live-traps and placed individually within a metabolic chamber maintained at 20 ± 1°C. Resting metabolic rate was determined using an open-circuit respirometry system. Season was significantly correlated with RMR, but no effects of age or sex were detected. Summer RMR values were significantly higher than winter values (mass-adjusted mean ± standard error: 2366 ± 70 kJ⋅d-1; 1845 ± 109 kJ⋅d-1, respectively), with the percentage difference being 24.7%. While under the influence of anaesthesia, RMR was estimated to be 25.5% lower than the combined average value before administration, and after recovery from anaesthesia. Resting metabolic rate during the autumn and winter was not significantly different to allometric predictions of basal metabolic rate for mustelid species weighing 1 kg or greater, but badgers measured in the summer had values that were higher than predicted. Results suggest that a seasonal reduction in RMR coincides with apparent reductions in physical activity and body temperature as part of the overwintering strategy ('winter lethargy') in badgers. This study contributes to an expanding dataset on the ecophysiology of medium-sized carnivores, and emphasises the importance of considering season when making predictions of metabolic rate.

Recovery of Sleep or Recovery of Self? A Grounded Theory Study of Residents’ Decision Making Regarding How to Spend Their Nonclinical Postcall Time

Purpose: As resident work hours policies evolve, residents’ off-duty time remains poorly understood. Despite assumptions about how residents should be using their postcall, off-duty time, there is little research on how residents actually use this time and the reasoning underpinning their activities. This study sought to understand residents’ nonclinical postcall activities when they leave the hospital, their decision-making processes, and their perspectives on the relationship between these activities and their well-being or recovery.

Method: The study took place at a Liaison Committee on Medical Education–accredited Canadian medical school from 2012 to 2014. The authors recruited a purposive and convenience sample of postgraduate year 1–5 residents from six surgical and nonsurgical specialties at three hospitals affiliated with the medical school. Using a constructivist grounded theory approach, semistructured interviews were conducted, audio-taped, transcribed, anonymized, and combined with field notes. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking.

Results: Twenty-four residents participated. Residents characterized their predominant approach to postcall decision making as one of making trade-offs between multiple, competing, seemingly incompatible, but equally valuable, activities. Participants exhibited two different trade-off orientations: being oriented toward maintaining a normal life or toward mitigating fatigue.

Conclusions: The authors’ findings on residents’ trade-off orientations suggest a dual recovery model with postcall trade-offs motivated by the recovery of sleep or of self. This model challenges the dominant viewpoint in the current duty hours literature and suggests that the duty hours discussion must be broadened to include other recovery processes.

The role of the cerebral cortex in postural responses to externally induced perturbations

The ease with which we avoid falling down belies a highly sophisticated and distributed neural network for controlling reactions to maintain upright balance. Although historically these reactions were considered within the sub cortical domain, mounting evidence reveals a distributed network for postural control including a potentially important role for the cerebral cortex. Support for this cortical role comes from direct measurement associated with moments of induced instability as well as indirect links between cognitive task performance and balance recovery. The cerebral cortex appears to be directly involved in the control of rapid balance reactions but also setting the central nervous system in advance to optimize balance recovery reactions even when a future threat to stability is unexpected. In this review the growing body of evidence that now firmly supports a cortical role in the postural responses to externally induced perturbations is presented. Moreover, an updated framework is advanced to help understand how cortical contributions may influence our resistance to falls and on what timescale. The implications for future studies into the neural control of balance are discussed.

Substance use and misuse in burn patients: testing the classical hypotheses of the interaction between posttraumatic symptomatology and substance use

Background: We aimed to test whether the three classical hypotheses of the interaction between posttraumatic symptomatology and substance use (high risk of trauma exposure, susceptibility for posttraumatic symptomatology, and self-medication of symptoms), may be useful in the understanding of substance use among burn patients. Methods: We analysed substance use data (nicotine, alcohol, cannabis, amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures among burn patients admitted to a Burns Unit and enrolled in a longitudinal observational study. Lifetime substance use information (n = 246) was incorporated to analyses aiming to test the high risk hypothesis. Only patients assessed for psychopathology in a six months follow-up (n = 183) were included in prospective analyses testing the susceptibility and self-medication hypotheses. Results: Regarding the high risk hypothesis, results show a higher proportion of heroin and tranquilizer users compared to the general population. Furthermore, in line with the susceptibility hypothesis, higher levels of symptomatology were found in lifetime alcohol, tobacco and drug users during recovery. The self-medication hypothesis could be tested partially due to the hospital stay “cleaning” effect, but severity of symptoms was linked to caffeine, nicotine, alcohol and cannabis use after discharge. Conclusions: We found that the three classical hypotheses could be used to understand the link between traumatic experiences and substance use explaining different patterns of burn patient’s risk for trauma exposure and emergence of symptomatology.