Postoperative Pain Trajectories in Cardiac Surgery Patients

Poorly controlled postoperative pain is a longstanding and costly problem in medicine. The purposes of this study were to characterize the acute pain trajectories over the first four postoperative days in 83 cardiac surgery patients with a mixed effects model of linear growth to determine whether statistically significant individual differences exist in these pain trajectories, and to compare the quality of measurement by trajectory with conventional pain measurement practices. The data conformed to a linear model that provided slope (rate of change) as a basis for comparing patients. Slopes varied significantly across patients, indicating that the direction and rate of change in pain during the first four days of recovery from surgery differed systematically across individuals. Of the 83 patients, 24 had decreasing pain after surgery, 24 had increasing pain, and the remaining 35 had approximately constant levels of pain over the four postoperative days

Pain control in healthcare organizations: Developing effective disease management programs

Although medicine possesses the knowledge and technology for preventing or relieving most pain, poor pain control is still widespread. Unrelieved pain causes unnecessary suffering and increases health care expenditures. Among the barriers to improving pain control are poor provider education in pain management, misguided beliefs about the inevitability of pain and the dangers of pain medication, provider resistance to changing practice patterns, and administrative resistance to implementing improvements that incur short-term costs but lead to long-term savings. In short, poor pain relief in America\u27s health care institutions is a system issue, and improvement requires a system-wide change. An effective program for improving pain management requires a multidisciplinary team committed to the task, ideally a triad consisting of a physician, a nurse, and a pharmacist. The triad needs administrative support in order to undertake needs assessment, offer provider and patient education, and perform continuous cycles of assessment, intervention, and reassessment of pain management. A strong information management base and an analytic engine are essential so that the team can evaluate outcomes from multiple perspectives (provider, payer, patient). The triad should identify a service area with clear pain problems, demonstrate improvements in this area, and then systematically move to other service areas. Educating providers and patients about pain and its control is essential for bringing about change. Improved pain management is a win-win situation for patients and institutions alike. Patients and families benefit from reduced suffering and improved quality of life, while institutions can offer more cost-effective care to patients

Epidemiology of bloodstream infections in a multicenter retrospective cohort of liver transplant recipients

Although some studies have examined the epidemiology of bloodstream infections after liver transplantation, they were based in single centers and did not identify bloodstream infections treated in other hospitals. METHODS: We retrospectively examined a cohort of 7912 adult liver transplant recipients from 24 transplant centers using 2004 to 2012 International Classification of Diseases, Ninth Revision, Clinical Modification billing data from 3 State Inpatient Databases, and identified bloodstream infections, inpatient death, and cumulative 1-year hospital costs. Multilevel Cox regression analyses were used to determine factors associated with bloodstream infections and death. RESULTS: Bloodstream infections were identified in 29% (n = 2326) of liver transplant recipients, with a range of 19% to 40% across transplant centers. Only 63% of bloodstream infections occurring more than 100 days posttransplant were identified at the original transplant center. Bloodstream infections were associated with posttransplant laparotomy (adjusted hazard ratio [aHR], 1.52), prior liver transplant (aHR, 1.42), increasing age (aHR, 1.07/decade), and some comorbidities. Death was associated with bloodstream infections with and without septic shock (aHR, 10.96 and 3.71, respectively), transplant failure or rejection (aHR, 1.41), posttransplant laparotomy (aHR, 1.40), prior solid-organ transplant (aHR, 1.48), increasing age (aHR, 1.15/decade), and hepatitis C cirrhosis (aHR, 1.20). The risk of bloodstream infections and death varied across transplant centers. Median 1-year cumulative hospital costs were higher for patients who developed bloodstream infections within 1 year of transplant compared with patients who were bloodstream infection-free (US $229 806 vs US$111 313; P < 0.001). CONCLUSIONS: Bloodstream infections are common and costly complications after liver transplantation that are associated with a markedly increased risk of death. The incidence and risk of developing bloodstream infections may vary across transplant centers

Frequency-Domain Photon Migration in Turbid Media

An analytical model is presented for the propagation of diffuse photon density waves in turbid media. The frequency- and wavelength-dependence of photon density waves are measured using Frequency-domain Photon Migration (FDPM). Media optical properties, including absorption, transport, and fluorescence relaxation times are calculated from experimental results

Probing the structure and dynamics of molecular clusters using rotational wavepackets

The chemical and physical properties of molecular clusters can heavily depend on their size, which makes them very attractive for the design of new materials with tailored properties. Deriving the structure and dynamics of clusters is therefore of major interest in science. Weakly bound clusters can be studied using conventional spectroscopic techniques, but the number of lines observed is often too small for a comprehensive structural analysis. Impulsive alignment generates rotational wavepackets, which provides simultaneous information on structure and dynamics, as has been demonstrated successfully for isolated molecules. Here, we apply this technique for the firsttime to clusters comprising of a molecule and a single helium atom. By forcing the population of high rotational levels in intense laser fields we demonstrate the generation of rich rotational line spectra for this system, establishing the highly delocalised structure and the coherence of rotational wavepacket propagation. Our findings enable studies of clusters of different sizes and complexity as well as incipient superfluidity effects using wavepacket methods.Comment: 5 pages, 6 figure

Exploring athletes’ perceptions of coach stress in elite sport environments

The present study aimed to extend research that has focused on the identification of stressors associated with coaching practice by systematically evaluating how such stressors effect athletes, and more broadly, the coach-athlete relationship. A total of 13 professional and national level athletes were interviewed to address the three study aims: how they detect when a coach is encountering stressors; how coach experiences of stress effects them as an athlete; and, how effective the coach is when experiencing stress. Following content analysis, the data suggested athletes were able to detect when a coach was experiencing stress and this was typically via a variety of verbal and behavioural cues. Despite some positive effects of the coach experiencing stress, the majority were negative and varied across a range of personal influences on the athlete, and effects on the general coaching environment. It was also the broad view of the athletes that coaches were less effective when stressed, and this was reflected in performance expectations, perceptions of competence, and lack of awareness. The findings are discussed in relation to the existing theory and with reference to their implications for applied practice, future research, and development of the coach athlete relationship

Exploring athletes’ perceptions of coach stress in elite sport environments

The present study aimed to extend research that has focused on the identification of stressors associated with coaching practice by systematically evaluating how such stressors effect athletes, and more broadly, the coach-athlete relationship. A total of 13 professional and national level athletes were interviewed to address the three study aims: how they detect when a coach is encountering stressors; how coach experiences of stress effects them as an athlete; and, how effective the coach is when experiencing stress. Following content analysis, the data suggested athletes were able to detect when a coach was experiencing stress and this was typically via a variety of verbal and behavioural cues. Despite some positive effects of the coach experiencing stress, the majority were negative and varied across a range of personal influences on the athlete, and effects on the general coaching environment. It was also the broad view of the athletes that coaches were less effective when stressed, and this was reflected in performance expectations, perceptions of competence, and lack of awareness. The findings are discussed in relation to the existing theory and with reference to their implications for applied practice, future research, and development of the coach athlete relationship

Neuronal pentraxins mediate synaptic refinement in the developing visual system

Peer reviewedPublisher PD

Ramifications of Optical Pumping on the Interpretation of Time-Resolved Photoemission Experiments on Graphene

In pump-probe time and angle-resolved photoemission spectroscopy (TR-ARPES) experiments the presence of the pump pulse adds a new level of complexity to the photoemission process in comparison to conventional ARPES. This is evidenced by pump-induced vacuum space-charge effects and surface photovoltages, as well as multiple pump excitations due to internal reflections in the sample-substrate system. These processes can severely affect a correct interpretation of the data by masking the out-of-equilibrium electron dynamics intrinsic to the sample. In this study, we show that such effects indeed influence TR-ARPES data of graphene on a silicon carbide (SiC) substrate. In particular, we find a time- and laser fluence-dependent spectral shift and broadening of the acquired spectra, and unambiguously show the presence of a double pump excitation. The dynamics of these effects is slower than the electron dynamics in the graphene sample, thereby permitting us to deconvolve the signals in the time domain. Our results demonstrate that complex pump-related processes should always be considered in the experimental setup and data analysis.Comment: 9 pages, 4 figure

Geochemical and Strontium Isotope Characterization of Produced Waters from Marcellus Shale Natural Gas Extraction

Extraction of natural gas by hydraulic fracturing of the Middle Devonian Marcellus Shale, a major gas-bearing unit in the Appalachian Basin, results in significant quantities of produced water containing high total dissolved solids (TDS). We carried out a strontium (Sr) isotope investigation to determine the utility of Sr isotopes in identifying and quantifying the interaction of Marcellus Formation produced waters with other waters in the Appalachian Basin in the event of an accidental release, and to provide information about the source of the dissolved solids. Strontium isotopic ratios of Marcellus produced waters collected over a geographic range of ∼375 km from southwestern to northeastern Pennsylvania define a relatively narrow set of values (εSr SW = +13.8 to +41.6, where εSr SW is the deviation of the 87Sr/86Sr ratio from that of seawater in parts per 104); this isotopic range falls above that of Middle Devonian seawater, and is distinct from most western Pennsylvania acid mine drainage and Upper Devonian Venango Group oil and gas brines. The uniformity of the isotope ratios suggests a basin-wide source of dissolved solids with a component that is more radiogenic than seawater. Mixing models indicate that Sr isotope ratios can be used to sensitively differentiate between Marcellus Formation produced water and other potential sources of TDS into ground or surface waters