An equine pain face

AbstractObjectiveThe objective of this study was to investigate the existence of an equine pain face and to describe this in detail.Study designSemi-randomized, controlled, crossover trial.AnimalsSix adult horses.MethodsPain was induced with two noxious stimuli, a tourniquet on the antebrachium and topical application of capsaicin. All horses participated in two control trials and received both noxious stimuli twice, once with and once without an observer present. During all sessions their pain state was scored. The horses were filmed and the close-up video recordings of the faces were analysed for alterations in behaviour and facial expressions. Still images from the trials were evaluated for the presence of each of the specific pain face features identified from the video analysis.ResultsBoth noxious challenges were effective in producing a pain response resulting in significantly increased pain scores. Alterations in facial expressions were observed in all horses during all noxious stimulations. The number of pain face features present on the still images from the noxious challenges were significantly higher than for the control trial (p = 0.0001). Facial expressions representative for control and pain trials were condensed into explanatory illustrations. During pain sessions with an observer present, the horses increased their contact-seeking behavior.Conclusions and clinical relevanceAn equine pain face comprising ‘low’ and/or ‘asymmetrical’ ears, an angled appearance of the eyes, a withdrawn and/or tense stare, mediolaterally dilated nostrils and tension of the lips, chin and certain facial muscles can be recognized in horses during induced acute pain. This description of an equine pain face may be useful for improving tools for pain recognition in horses with mild to moderate pain

On the Phenomenology of Hydrodynamic Shear Turbulence

The question of a purely hydrodynamic origin of turbulence in accretion disks is reexamined, on the basis of a large body of experimental and numerical evidence on various subcritical (i.e., linearly stable) hydrodynamic flows. One of the main points of this paper is that the length scale and velocity fluctuation amplitude which are characteristic of turbulent transport in these flows scale like $Re_m^{-1/2}$, where $Re_m$ is the minimal Reynolds number for the onset of fully developed turbulence. From this scaling, a simple explanation of the dependence of $Re_m$ with relative gap width in subcritical Couette-Taylor flows is developed. It is also argued that flows in the shearing sheet limit should be turbulent, and that the lack of turbulence in all such simulations performed to date is most likely due to a lack of resolution, as a consequence of the effect of the Coriolis force on the large scale fluctuations of turbulent flows. These results imply that accretion flows should be turbulent through hydrodynamic processes. If this is the case, the Shakura-Sunyaev $\alpha$ parameter is constrained to lie in the range $10^{-3}-10^{-1}$ in accretion disks, depending on unknown features of the mechanism which sustains turbulence. Whether the hydrodynamic source of turbulence is more efficient than the MHD one where present is an open question.Comment: 31 pages, 3 figures. Accepted for publication in Ap

Motivating doctors into leadership and management: a cross-sectional survey

Purpose: Calls for doctors to enter management are louder as the benefits of medical leadership become clearer. But supply is not meeting demand. This study asks doctors: what might encourage you to go into leadership, and what do you see as the disincentives? The same was asked about leadership training. First, the paper attempts to understand doctors’ motivation to lead, specifically, to explore the job characteristics that might act as incentives and disincentives. Second, the study points to organisational obstacles that further shrink the medical leadership pipeline. Method: Doctors were surveyed through the Organization of Danish Medical Societies. Our key variables included: 1) willingness to take on a management or leadership position; 2) the incentives to go into leadership or management; 3) disincentives to do so; and 4) incentives for participating in leadership training. Our sample includes 3534 doctors (17% response rate). Findings: Nearly 70% of doctors said that they would consider leadership or management positions. Overwhelmingly, the main incentive reported was to have a positive impact. Doctors are put off by fears of extra administration, longer hours, burnout, lack of resources, and by organisational cultures resistant to change. But they are fully aware of their need for leadership training. Practical implications: Health systems should adapt to reflect the motivations of their potential medical leaders, especially the best talent, who may not be the first to apply for management positions. It is also essential they offer leadership training. These findings, that aid succession planning, are especially important as more is known about the influence of medical leaders on organisational outcomes, and at a time of high reported stress, burnout, and staff recruitment and retention challenges