Characterizing the role of haloperidol for analgesia in the Emergency Department

The purpose of this study was to characterize emergency department (ED) physicians' beliefs and current practices regarding the use of haloperidol for the management of acute and acute on chronic pain. METHODS: A survey regarding haloperidol use was distributed by email to attending physicians, resident physicians, nurse practitioners, and physician assistants at emergency medicine departments in the Indiana University Health System and at St Joseph Mercy Ann Arbor. RESULTS: Of the 129 responses received, the majority (89.1%) of providers had used haloperidol for control of pain in the ED. The most common reason that respondents used haloperidol to treat pain was that they did not want to use an opioid or other agent (91.3%). The majority of providers (73.9%) believed that haloperidol was effective because there is a psychiatric component to pain, while over half of respondents (58.3%) chose haloperidol as they believed it to have analgesic properties. When haloperidol was used as a first line medication, providers felt that it was effective in controlling pain about 69.0% of the time without the need for further medication. The most common presentations for use were for unspecified abdominal pain, headache, and gastroparesis. CONCLUSION: ED providers reported using haloperidol most often as a second line treatment to manage both acute and acute on chronic pain. When haloperidol was used as a first line agent, providers claimed that additional medicines were not usually required. Haloperidol may provide an effective alternative to opioids in treatment of acute pain and acute exacerbations of chronic pain in the ED

Avoiding Costly Conservation Mistakes: The Importance of Defining Actions and Costs in Spatial Priority Setting

Background: The typical mandate in conservation planning is to identify areas that represent biodiversity targets within the smallest possible area of land or sea, despite the fact that area may be a poor surrogate for the cost of many conservation actions. It is also common for priorities for conservation investment to be identified without regard to the particular conservation action that will be implemented. This demonstrates inadequate problem specification and may lead to inefficiency: the cost of alternative conservation actions can differ throughout a landscape, and may result in dissimilar conservation priorities

Extent of exposure to environmental tobacco smoke (ETS) and its dose-response relation to respiratory health among adults

BACKGROUND: There is a dearth of standardized studies examining exposure to environmental tobacco smoke (ETS) and its relationship to respiratory health among adults in developing countries. METHODS: In 2004, the Syrian Center for Tobacco Studies (SCTS) conducted a population-based survey using stratified cluster sampling to look at issues related to environmental health of adults aged 18–65 years in Aleppo (2,500,000 inhabitants). Exposure to ETS was assessed from multiple self-reported indices combined into a composite score (maximum 22), while outcomes included both self-report (symptoms/diagnosis of asthma, bronchitis, and hay fever), and objective indices (spirometric assessment of FEV(1 )and FVC). Logistic and linear regression analyses were conducted to study the relation between ETS score and studied outcomes, whereby categorical (tertiles) and continuous scores were used respectively, to evaluate the association between ETS exposure and respiratory health, and explore the dose-response relationship of the association. RESULTS: Of 2038 participants, 1118 were current non-smokers with breath CO levels ≤ 10 ppm (27.1% men, mean age 34.7 years) and were included in the current analysis. The vast majority of study participants were exposed to ETS, whereby only 3.6% had ETS score levels ≤ 2. In general, there was a significant dose-response pattern in the relationship of ETS score with symptoms of asthma, hay fever, and bronchitis, but not with diagnoses of these outcomes. The magnitude of the effect was in the range of twofold increases in the frequency of symptoms reported in the high exposure group compared to the low exposure group. Severity of specific respiratory problems, as indicated by frequency of symptoms and health care utilization for respiratory problems, was not associated with ETS exposure. Exposure to ETS was associated with impaired lung function, indicative of airflow limitation, among women only. CONCLUSIONS: This study provides evidence for the alarming extent of exposure to ETS among adult non-smokers in Syria, and its dose-response relationship with respiratory symptoms of infectious and non-infectious nature. It calls for concerted efforts to increase awareness of this public health problem and to enforce regulations aimed at protecting non-smokers

Yeast Bax Inhibitor, Bxi1p, Is an ER-Localized Protein That Links the Unfolded Protein Response and Programmed Cell Death in Saccharomyces cerevisiae

Bax inhibitor-1 (BI-1) is an anti-apoptotic gene whose expression is upregulated in a wide range of human cancers. Studies in both mammalian and plant cells suggest that the BI-1 protein resides in the endoplasmic reticulum and is involved in the unfolded protein response (UPR) that is triggered by ER stress. It is thought to act via a mechanism involving altered calcium dynamics. In this paper, we provide evidence that the Saccharomyces cerevisiae protein encoded by the open reading frame, YNL305C, is a bona fide homolog for BI-1. First, we confirm that yeast cells from two different strain backgrounds lacking YNL305C, which we have renamed BXI1, are more sensitive to heat-shock induced cell death than wildtype controls even though they have indistinguishable growth rates at 30°C. They are also more susceptible both to ethanol-induced and to glucose-induced programmed cell death. Significantly, we show that Bxi1p-GFP colocalizes with the ER localized protein Sec63p-RFP. We have also discovered that Δbxi1 cells are not only more sensitive to drugs that induce ER stress, but also have a decreased unfolded protein response as measured with a UPRE-lacZ reporter. Finally, we have discovered that deleting BXI1 diminishes the calcium signaling response in response to the accumulation of unfolded proteins in the ER as measured by a calcineurin-dependent CDRE-lacZ reporter. In toto, our data suggests that the Bxi1p, like its metazoan homologs, is an ER-localized protein that links the unfolded protein response and programmed cell death

Astrophysical magnetic fields and nonlinear dynamo theory

The current understanding of astrophysical magnetic fields is reviewed, focusing on their generation and maintenance by turbulence. In the astrophysical context this generation is usually explained by a self-excited dynamo, which involves flows that can amplify a weak 'seed' magnetic field exponentially fast. Particular emphasis is placed on the nonlinear saturation of the dynamo. Analytic and numerical results are discussed both for small scale dynamos, which are completely isotropic, and for large scale dynamos, where some form of parity breaking is crucial. Central to the discussion of large scale dynamos is the so-called alpha effect which explains the generation of a mean field if the turbulence lacks mirror symmetry, i.e. if the flow has kinetic helicity. Large scale dynamos produce small scale helical fields as a waste product that quench the large scale dynamo and hence the alpha effect. With this in mind, the microscopic theory of the alpha effect is revisited in full detail and recent results for the loss of helical magnetic fields are reviewed.Comment: 285 pages, 72 figures, accepted by Phys. Re

Children and parents living with a family member with mental illness

The importance of collaboration and partnerships in the delivery of effective services is a notion that is well established in the literature, for example, the recent evaluation of the former Stronger Families and Communities Strategy. This article describes a partnership between practitioners and researchers. The Mental Health Community Based Program funded by the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA), and one of the projects within this initiative, is described. A complementary research (PhD) project being undertaken by the first author (Vicki Cowling), and the processes involved in establishing the partnership and working together between agency and researcher, are then outlined

Raising the bar for systematic conservation planning

Systematic conservation planning (SCP) represents a significant step toward cost-effective, transparent allocation of resources for biodiversity conservation. However, research demonstrates important consequences of uncertainties in SCP and of basing methods on simplified circumstances involving few real-world complexities. Current research often relies on single case studies with unknown forms and amounts of uncertainty as well as low statistical power for generalizing results. Consequently, conservation managers have little evidence for the true performance of conservation planning methods in their own complex, uncertain applications. To build effective and reliable methods in SCP, there is a need for more challenging and integrated testing of their robustness to uncertainty and complexity, and much greater emphasis on generalization to real-world situations