Morphologic adjustments of actively evolving highly curved neck cutoffs

Neck cutoffs and their resultant oxbow lakes are important and prominent features of riverine landscapes. Detailed field-based research focusing on the morphologic evolution of neck cutoffs is currently insufficient to fully characterize cutoff evolution. High-resolution bathymetric data were collected over 3 years for the purpose of determining channel morphology and morphologic change on three actively evolving neck cutoffs. Results indicate the following general trends in morphologic adjustment: (1) a longitudinal bar in the upstream meander limb that develops near the entrance to the abandoned bend; (2) a deep scour hole in the downstream meander limb immediately downstream of the cutoff channel; (3) erosion of the bank opposite the cutoff in the downstream meander limb; (4) a cutoff bar in the downstream meander limb at the junction corner of the cutoff channel and the downstream meander limb; and (5) perching of the exit of the abandoned bend above the cutoff channel due to channel bed incision. The results presented herein were used to develop a conceptual model that depicts the morphologic evolution of highly curving neck cutoffs. The findings of this research are combined with recent analyses of the three-dimensional flow structure through neck cutoffs to provide a mechanistic explanation for the morphodynamics of neck cutoffs. (c) 2019 John Wiley & Sons, Ltd

Is positive communication sufficient to modulate procedural pain and anxiety in the emergency room? A randomized controlled trial.

Research suggests that therapeutic communication could enhance patient comfort during medical procedures. Few studies have been conducted in clinical settings, with adequate blinding. Our hypothesis was that a positive message could lead to analgesia and anxiolysis, and that this effect would be enhanced by an empathetic interaction with the nurse performing the procedure, compared to an audio-taped message. This study aimed to modulate the contents and delivery vector of a message regarding peripheral intravenous catheter (PIC) placement in the emergency room (ER). This study was a 2 + 2 randomized controlled trial registered on clinicaltrials.gov (NCT03502655). A positive versus standard message was delivered through audio tape (double blind) in the first phase (N = 131) and through the nurse placing the catheter (single blind) in the second phase (N = 120). By design, low practitioner empathic behavior was observed in the first phase (median 1 out of 5 points). In the second phase, higher empathic behavior was observed in the positive than in the standard message (median 2 vs. 3, p < 0.001). Contrary to our hypothesis, the intervention did not affect pain nor anxiety reports due to PIC placement in either phase (all p values>0.2). The positive communication intervention did not impact pain nor anxiety reports following PIC. There might have been a floor effect, with low PIC pain ratings in a context of moderate pain due to the presenting condition. Hence, such a therapeutic communication intervention might not be sufficient to modulate a mild procedural pain in the ER

Motor function evaluation in merosin-deficient congenital muscular dystrophy children

Congenital muscular dystrophy (CMD) is a heterogeneous group of disorders characterized by early onset of hypotonia and weakness. Almost 50% of the cases are caused by primary deficiency of a protein named merosin (MD), and present a homogenous phenotype with a severe motor and respiratory involvement. Eleven children with clinical and histological diagnosis of CMD-MD, aged of 3 to 15 years, were studied using the manual muscle testing (Medical Research Council), goniometric analysis, motor ability and day life activities (Barthel index) scales, with the objective to characterize the main motor function limitations. The muscular groups most affected were cervical flexors, paravertebral and proximal portions of limbs. The muscular groups of upper limbs were as affected as the lower limbs, and the extensors were more affected than the flexors groups. All children had severe muscular retractions on the hip, knee and elbow. Other frequent deformities were scoliosis and equinus-varum feet. No children presented the motor ability to walk, stand up and crawl; and all of them were classified as dependents or semi-dependents in the day life activities scale. Our findings confirm the severe and diffuse involvement of skeletal muscle in CMD-MD patients, producing serious motor limitations and deformities.A distrofia muscular congênita (DMC) compõe um grupo de miopatias caracterizadas por hipotonia e fraqueza muscular notadas até o primeiro ano de vida. Em torno de 40% a 50% dos casos são decorrentes de deficiência primária da proteína merosina (DM), os quais apresentam um fenótipo mais homogêneo, com grave comprometimento motor e respiratório. Foram avaliadas neste estudo onze crianças com diagnóstico clínico e histológico de DMC-DM, com idade de 3 a 15 anos, através de exame de força muscular (Medical Research Council), análise goniométrica, avaliação das habilidades motoras e das atividades de vida diária (AVDs) (indicador de Barthel), com o objetivo de caracterizar as principais limitações funcionais motoras. Os grupos musculares mais comprometidos foram os flexores cervicais, paravertebrais e proximais dos membros. Os grupos musculares dos membros superiores estavam tão comprometidos quanto os dos membros inferiores, enquanto que os extensores encontravam-se mais comprometidos que os flexores. Todas as crianças apresentavam importantes retrações musculares nos quadris, joelhos e cotovelos. Outras deformidades freqüentes foram escoliose e pés eqüino-varo. Nenhuma criança possuía a habilidade motora necessária para engatinhar, ficar de pé ou andar; e todas foram classificadas como dependentes ou semidependentes para a maioria das AVDs estudadas. Nossos achados confirmam o envolvimento difuso e intenso da musculatura esquelética na DMC-DM, acarretando graves limitações funcionais motoras e deformidades músculo-esqueléticas.Associação de Assistência à Criança Deficiente Clínica de Doenças NeuromuscularesUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Het ontwerpen van een nieuw duurzaam bewaar- en verwerkingssysteem voor bloembollen

De huidige bewaar-, verwerkings- en ontsmettingssystemen voor bloembollen functioneren verre van optimaal: de bewaring wordt gekenmerkt door een hoog energieverbruik, tijdens het verwerken en ontsmetten treedt verspreiding van ziekten op, en stress en verwonding van de bollen dragen bij aan uitval door ziekten en andere vormen van kwaliteitsverlies. Daarnaast staat het ontsmetten onder grote druk door de risico’s van blootstelling van medewerkers en emissie van middelen naar het milieu. Het sorteren van bollen voorkomt niet dat in de broeierij grote variatie in groeisnelheid en bloemkwaliteit optreedt en de onmogelijkheid om bollen geautomatiseerd rechtop te planten brengt hoge arbeidskosten met zich mee. Dit project had tot doel innovatieve technieken voor de verschillende onderdelen van het verwerken (inclusief ontsmetten) en bewaren te inventariseren en die te integreren tot een totaalsysteem waarin energiezuinig bewaard wordt, blootstelling aan en emissie van middelen tot het verleden behoren, en gezondere en kwalitatief betere bollen geproduceerd worden

Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment

<p>Abstract</p> <p>Background</p> <p>This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration.</p> <p>Methods</p> <p>Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis.</p> <p>Results</p> <p>The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error.</p> <p>Conclusions</p> <p>The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students' or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development.</p