Change in pain severity with open label venlafaxine use in patients with a depressive symptomatology: an observational study in primary care

PURPOSE: Venlafaxine has shown benefit in the treatment of depression and pain. Worldwide data are extensively lacking investigating the outcome of chronic pain patients with depressive symptoms treated by venlafaxine in the primary care setting. This observational study aimed to elucidate the efficacy of venlafaxine and its prescription by Swiss primary care physicians and psychiatrists in patients with chronic pain and depressive symptomatology. SUBJECTS AND METHODS: We studied 505 patients with depressive symptoms suffering from chronic pain in a prospective naturalistic Swiss community based observational trial with venlafaxine in primary care. These patients have been treated with venlafaxine by 122 physicians, namely psychiatrists, general practitioners, and internists. RESULTS: On average, patients were treated with 143+/-75 mg (0-450 mg) venlafaxine daily for a follow-up of three months. Venlafaxine proved to be beneficial in the treatment of both depressive symptoms and chronic pain. DISCUSSION: Although side effects were absent in most patients, physicians might have frequently omitted satisfactory response rate of depression by underdosing venlafaxine. Our results reflect the complexity in the treatment of chronic pain in patients with depressive symptoms in primary care. CONCLUSION: Further randomized dose-finding studies are needed to learn more about the appropriate dosage in treating depression and comorbid pain with venlafaxine.

Contact system activation in human sepsis - 47kD HK, a marker of sepsis severity?

AIM: This pilot study seeks to determine whether contact system activation (CSA) occurs in human sepsis patients and to characterise blood levels of the 47kD light chain of high-molecular weight kininogen (47kD HK). METHODS: Six consecutive patients with clinical suspicion of sepsis were evaluated on days 1, 2, 3 and 6-8 for 47kD HK blood levels expressed in U/ml of whole blood and as percent of total HK. 47kD HK was measured in whole blood by quantitative immunoblot analysis. RESULTS: On study day 1 or 2, analysis of 47kD HK in U/ml of whole blood identified CSA in 3/6 patients.When 47kD HK levels were expressed as percent of total HK, 4/6 patients were identified with CSA before day 3. The degree of CSA as assayed by the presence of 47kD HK correlated with the severity of the systemic inflammatory syndrome (SIRS), i.e. mean CSA increased progressively from basal levels in healthy controls (0.08 U/ml or 10.4%) to patients without SIRS (0.10 U/ml or 15.1%), to patients with sepsis (0.12 U/ml or 15.0%), and finally to patients in a combined category of severe sepsis and septic shock (0.13 U/ml or 17.4%). CONCLUSION: CSA, defined by increased 47kD HK, occurred early on in the course of sepsis in a subset of sepsis patients. 47kD HK levels, an indicator of bradykinin release, correlated with sepsis severity. Future larger studies will need to evaluate the role of 47kD HK as a biomarker for both prognosis and treatment response in human sepsis..

THE INFLUENCE OF DIET COMPOSITION, PLANT DEFENSIVE CHEMICALS, AND WINTER SEVERITY ON THE NUTRITIONAL CONDITION OF A FREERANGING, GENERALIST HERBIVORE

Herbivory requires animals to manage intake of toxic phytochemicals. Detoxification and excretion of these chemicals prevents toxicity, but is energetically expensive. I investigated the relationship between investment in detoxification and nutritional condition for moose on Isle Royale National Park (Alces alces) during winter, using urinary indices from urine samples collected in snow. The ratio of urinary urea nitrogen:creatinine is an indicator of nutritional condition, and the ratio of glucuronic acid:creatinine is an indicator of investment in detoxification. Nutritional condition declined with greater investment in detoxification. An alternative means of managing defensive chemical intake is to diversify the diet. Microhistological analysis of fecal pellets determined diet composition. Diet diversity was weakly associated with improved nutritional condition. However, the strongest predictors of nutritional condition were winter severity and proportion of balsam fir in the diet (a dominant food for moose in this ecosystem).

Effects of gender and dementia severity on Alzheimer's disease caregivers' sleep and biomarkers of coagulation and inflammation

BACKGROUND: Being a caregiver for a spouse with Alzheimer's disease is associated with increased risk for cardiovascular illness, particularly for males. This study examined the effects of caregiver gender and severity of the spouse's dementia on sleep, coagulation, and inflammation in the caregiver. METHODS: Eighty-one male and female spousal caregivers and 41 non-caregivers participated (mean age of all participants 70.2 years). Full-night polysomnography (PSG) was recorded in each participants home. Severity of the Alzheimer's disease patient's dementia was determined by the Clinical Dementia Rating (CDR) scale. The Role Overload scale was completed as an assessment of caregiving stress. Blood was drawn to assess circulating levels of D-dimer and Interleukin-6 (IL-6). RESULTS: Male caregivers who were caring for a spouse with moderate to severe dementia spent significantly more time awake after sleep onset than female caregivers caring for spouses with moderate to severe dementia (p=.011), who spent a similar amount of time awake after sleep onset to caregivers of low dementia spouses and to non-caregivers. Similarly, male caregivers caring for spouses with worse dementia had significantly higher circulating levels of D-dimer (p=.034) than females caring for spouses with worse dementia. In multiple regression analysis (adjusted R(2)=.270, p<.001), elevated D-dimer levels were predicted by a combination of the CDR rating of the patient (p=.047) as well as greater time awake after sleep onset (p=.046). DISCUSSION: The findings suggest that males caring for spouses with more severe dementia experience more disturbed sleep and have greater coagulation, the latter being associated with the disturbed sleep. These findings may provide insight into why male caregivers of spouses with Alzheimer's disease are at increased risk for illness, particularly cardiovascular disease.

Performance-Based Engineering Framework for Earthquake and Fire Following Earthquake

The objective for this thesis is to outline a Performance-Based Engineering (PBE) framework to address the multiple hazards of Earthquake (EQ) and subsequent Fire Following Earthquake (FFE). Currently, fire codes for the United States are largely empirical and prescriptive in nature. The reliance on prescriptive requirements makes quantifying sustained damage due to fire difficult. Additionally, the empirical standards have resulted from individual member or individual assembly furnace testing, which have been shown to differ greatly from full structural system behavior. The very nature of fire behavior (ignition, growth, suppression, and spread) is fundamentally difficult to quantify due to the inherent randomness present in each stage of fire development. The study of interactions between earthquake damage and fire behavior is also in its infancy with essentially no available empirical testing results. This thesis will present a literature review, a discussion, and critique of the state-of-the-art, and a summary of software currently being used to estimate loss due to EQ and FFE. A generalized PBE framework for EQ and subsequent FFE is presented along with a combined hazard probability to performance objective matrix and a table of variables necessary to fully implement the proposed framework. Future research requirements and summary are also provided with discussions of the difficulties inherent in adequately describing the multiple hazards of EQ and FFE.

Concept Fire Truck

A prototype Concept Fire Truck was designed using Autodesk Inventor 3D Design Software. Various pictures of old-time and toy fire trucks were utilized for this project. The prototype was printed using a 3D printer to verify that all parts of the truck would fit and work as intended.

Developing Higher-level Cognitive Skills In a Fire Protection Course

In an ideal world, all instructors of safety and health courses would be masters of course subject matter as well as the theories and practices for effective teaching. In practice, however, most instructors are much stronger in one or the other. This paper provides an example of how some fundamental knowledge from educational experts can be useful for improving a traditional safety course. Is there a problem with the way traditional safety and health (S&H) courses are taught? It is asserted by this author that S&H education, in general, places too much emphasis on acquisition and comprehension of facts at the expense of helping students develop higher-level cognitive abilities. This paper explains the basis for the assertion and reports an experience upgrading a traditional fire protection course to include more assignments involving the higher-level ability known in the education community as synthesis.

Strengthening a Traditional Fire Protection Course by Using Fault Trees

Traditional courses and textbooks in occupational safety emphasize rules, standards, and guidelines. This paper describes the early stage of a project to upgrade a traditional college course on fire protection by incorporating learning materials to develop the higher-level cognitive ability known as synthesis. Students will be challenged to synthesize textbook information into fault tree diagrams. The paper explains the place of synthesis in Bloom’s taxonomy of cognitive abilities and the utility of fault trees diagrams as a tool for synthesis. The intended benefits for students are: improved abilities to synthesize, a deeper understanding of fire protection practices, ability to construct fault trees for a wide range of undesired occurrences, and perhaps recognition that heavy reliance on memorization is the hard way to learn occupational safety and health.

Communicating Severity of Hazard with the Signal Word on a Safety Sign

An experiment examined five signal words on safety signs for effectiveness at communicating information about severity of a hazard. Perceived severity was rated by 59 college students for the signal words Deadly, Danger, Warning, Caution, and Notice. Results indicated that Deadly communicated the highest ratings for severity. Danger was second. Warning and Caution were tied for third. The lowest ratings were for Notice.

Effectiveness of Colors used on Safety and Health Signs for Communicating Severity of Injury

Signs are used extensively in workplaces and on products to identify hazards and provide instructions for appropriate behavior. A fundamental element of these signs is the signal-word panel located at the top of the sign. The colors and words in this panel are intended to convey information about the hazard identified. One type of hazard information concerns the severity of injury/illness associated with the hazard. The standard of the American National Standards Institute (ANSI) for facility signs uses three severity categories: 1) death or serious injury, 2) minor or moderate injury, and 3) property damage. The standard specifies which signal-word panel format, including color, to use based in part on the severity category. The purpose of this study was to determine if college students associate color with severity. The sample population consisted of 59 students tested in nine small groups. Twelve signs were shown to them in random order. Five of the signs had a color for the background of the signal-word panel. The colors were red, orange, yellow, blue, and gray. The signal word was a nonsense word and the text panel contained repetitions of the letter x in sentence format. Subject rated their impressions of the colors using two ordered rating scales for severity. Results indicated that color had a highly significant effect on severity ratings. Median ratings were generally consistent with the ANSI standard, except for orange. Red rated highest on both scales. Blue and gray rated lowest. Yellow and orange were in between red and blue. According to the ANSI standard, orange should indicate the same severity as red. These results indicated that orange was associated with less severity than red. Apparently, the ANSI standard's use of orange to identify a hazard associated with death or a serious injury is questionable.

Comparison of Student Versus Employee Test Populations for Warning Sign Research Based on Severity Ratings for Signal Words

Most studies of warning signs involve undergraduate students as subjects. This paper reports a direct comparison of findings from an undergraduate population and an employed population. The 48 employed subjects from this study were compared with 59 undergraduate subjects from a companion study. Subjects from both populations were shown the same signs and asked to rate the severity level connoted by each sign. The signs differed only in signal word. Results for each population indicated that signal word had a highly significant effect on severity ratings. When the two populations were compared for ratings of each signal word, the only significant difference was for Caution. Median ratings of each population were the same: Deadly (4), Danger (3), Warning (2), Caution (1), and Notice (0).

Four thousand years of vegetation and fire history in the spruce forests of northern Kyrgyzstan (Kungey Alatau, Central Asia)

Analyses of pollen, macrofossils and microscopic charcoal in the sediment of a small sub-alpine lake (Karakol, Kyrgyzstan) provide new data to reconstruct the vegetation history of the Kungey Alatau spruce forest during the late-Holocene, i.e. the past 4,000 years. The pollen data suggest that Picea schrenkiana F. and M. was the dominant tree in this region from the beginning of the record. The pollen record of pronounced die-backs of the forests, along with lithostratigraphical evidence, points to possible climatic cooling (and/or drying) around 3,800 cal year B.P., and between 3,350 and 2,520 cal year B.P., with a culmination at 2,800-2,600 cal B.P., although stable climatic conditions are reported for this region for the past 3,000-4,000 years in previous studies. From 2,500 to 190 cal year B.P. high pollen values of P. schrenkiana suggest rather closed and dense forests under the environmental conditions of that time. A marked decline in spruce forests occurred with the onset of modern human activities in the region from 190 cal year B.P. These results show that the present forests are anthropogenically reduced and represent only about half of their potential natural extent. As P. schrenkiana is a species endemic to the western Tien Shan, it is most likely that its refugium was confined to this region. However, our palaeoecological record is too recent to address this hypothesis thoroughly.