Evaluating comfort measures for commonly performed painful procedures in pediatric patients.

Introduction: Management of pediatric pain from medical procedures is of great importance for improving both patient care and experience. In this study, we investigated methods of managing acute pain in infants and children by studying the correlation between the number of attempts to complete painful procedures, given different comfort measures. Methods: The study is a retrospective review of 74,276 procedures performed at two pediatric hospitals in an integrated academic children\u27s health system between 2013 and 2016. We compared three comfort measures most frequently offered: positions of comfort (POC), distraction (DIST), and pharmacological (PHARM). These methods were compared in the setting of four procedures: peripheral intravenous (PIV) catheter insertion, gastrointestinal tube placement, incision procedures, and bladder catheterization. We used the number of attempts needed to complete a procedure as a measure of efficacy minimizing distressing experience in an acutely painful setting (single attempt vs repeat attempts). Results: Among younger children, DIST appears superior to the other two methods; it performs significantly better for three of the four procedures (PIV catheterization, incision wound, and urinary catheterization) among infants agedchildren, POC tends to perform slightly better than the other two methods, although it is significantly better only for PIV catheterization among adolescents aged 13-21 years and urinary catheterization among children aged 9-12 years. Conclusion: Results from this study may be used to determine appropriate comfort measures for painful procedures in pediatric setting

Bai Use in Forest Elephants (Loxodonta africana cyclotis): Ecology, Sociality & Risk

Forest elephant (Loxodonta africana cyclotis) sociality is relatively little-studied due to the difficulties of making direct observations in rainforests. In Central Africa elephants aggregate at large natural forest clearings known as bais, which have been postulated to offer social benefits in addition to nutritional resources. This thesis explores the role of these clearings as social arenas by examining bai use within three main themes; ecology, sociality and risk factors. Seasonal changes in elephant use of the Maya Nord bai (Republic of Congo) are described, along with the demography of the visiting population. Elephant visit rate was highly variable; the number of elephants using Maya Nord in an observation day ranged from 0 to 117 animals. This variability was unrelated to local resource availability and productivity suggesting that bai use occurs year round. Elephants in Odzala-Kokoua do not show high fidelity to a single clearing; 454 elephants were individually identified and re-sighted an average of 1.76 times (range 1-10) during the twelve month study period. Previous bai studies have yet to quantify how elephants associate with one another within the bai area. This study examines socio-spatial organisation and associate choice using two measures of association within the 0.23 km2 bai area; aggregations (all elephants present in the clearing) and parties (elephants spatially co-ordinated in activity and movement) and distinguishes these from parties that range together (i.e. arrive and leave together). Social network analyses (SocProg) were used to describe inter- and intra-sexual multi-level organisation in the bai environment, and to illustrate the non-random nature of elephant aggregations and parties. Bais were shown to function as social arenas; female elephants showed active choice of certain associates and active avoidance of others when creating parties, whereas males were less discriminatory. Parties formed in the clearing (mean size= 3.93, SE= 0.186) were larger than ranging parties (mean size= 2.71, SE= 0.084) and elephants stayed for 50% longer in the clearing when they associated with individuals from outside their ranging party. Inter- and intra-sexual relationships were maintained within the clearing, and these are suggested to offer elephants essential opportunities for social learning. The patterning and nature of the relationships observed at the Maya Nord clearing indicates that forest elephants use a fission-fusion social structure similar to that of savannah elephants (Loxodonta africana africana); relationships are significantly structured by age- and sex- and underpinned by individual identity. Old experienced females hold key roles for forest elephants, and male relationships are superimposed on the network of female associations. Odzala-Kokoua elephants use bais to maintain their social relationships despite being highly sensitive to the anthropogenic risks involved in using these open areas. The results of this study suggest that forest and savannah elephants lie on the same social continuum, balancing social “pulls” to aggregate against the ecological “pushes” that force groups to fission. Previous models of savannah elephant sociality construct levels of association and social complexity upwards from the basic mother-calf unit (e.g. Wittemyer & Getz 2007). My results suggest that it may be more appropriate to consider elephant sociality and associations as in dynamic equilibrium between social and ecological influences acting at all levels of grouping, and to explicitly test how these underlie the opportunity costs that elephants are willing to pay in order to maintain social groupings

The consequences of poaching and anthropogenic change for forest elephants

Poaching has devastated forest elephant populations (Loxodonta cyclotis), and their habitat is dramatically changing. The long-term effects of poaching and other anthropogenic threats have been well studied in savannah elephants (Loxodonta africana), but the impacts of these changes for Central Africa's forest elephants have not been discussed. We examine potential repercussions of these threats and the related consequences for forest elephants in Central Africa by summarizing the lessons learned from savannah elephants and small forest elephant populations in West Africa. Forest elephant social organisation is little known than for savannah elephants, but the close evolutionary history with savannah elephants suggests that they will respond to anthropogenic threats in broadly similar ways. The loss of older, experienced individuals could disrupt ecological, social and population parameters. Severe reduction of elephant abundance within Central Africa's forests can alter plant communities and ecosystem functions. Poaching, habitat alterations and human population increase are probably compressing forest elephants into protected areas and increasing human-elephant conflict, negatively affecting their conservation. We encourage conservationists to look beyond forest elephant population decline and address these causes of change when developing conversation strategies. We propose research priorities, including assessing the effectiveness of the existing protected area network for landscape connectivity in the light of current industrial and infrastructure development. Longitudinal assessments of landscape changes on forest elephant sociality and behaviour are also needed. Finally, lessons learned from West African population loss and fragmentation should be used to inform strategies for land-use planning and managing the human-elephant interface

Quantifying forest elephant social structure in Central African bai environments

Relatively little is known of social dynamics in forest elephants (Loxodonta africana cyclotis), although the fission-fusion model of sociality known in savannah elephants (Loxodonta africana africana) is used as a template. Until fission-fusion sociality or an alternative model is demonstrated, our understanding of how elephants use their environment remains incomplete. To date, there have been no published studies of associations between individuals in forest elephants. Direct observations of forest elephants made at forest clearings (bais) are here used as an approach to studying these questions. Bais represent a special environment, providing mineral and food resources, as well as potential social opportunities. We show that forest elephants at Mbeli Bai in Nouabalé-Ndoki National Park have association patterns that are consistent over time, and that certain conspecifics are preferred as associates in the bai environment. Coupled with significant differences in the group size and composition across age-sex classes, and a high proportion of sightings of lone individuals, we argue that the fission-fusion model of elephant sociality appears to hold for the bai environment. The extent of this system and the importance of bais as social resources remain to be explored

The Catalytic Intramolecular Friedel-Crafts Acylation of Meldrum's Acid Derivatives and The Total Synthesis of Taiwaniaquinol B

The intramolecular Friedel-Crafts acylation of aromatics with Meldrum?s acid derivatives catalyzed by metal trifluoromethanesulfonates and other Lewis acids is reported. Meldrum?s acids are easily prepared, functionalized, handled, and purified. The synthesis of polysubstituted 1-indanones from benzyl Meldrum's acids was investigated thoroughly, and it was shown that a variety of catalysts were effective, whilst accommodating a diversity of functional groups under mild conditions. The scope, limitations, and functional group tolerance (terminal alkene and alkyne, ketal, dialkyl ether, dialkyl thioether, aryl methyl ether, aryl TIPS and TBDPS ethers, nitrile- and nitro-substituted aryls, alkyl and aryl halides) for a variety of 5-benzyl (enolizable Meldrum?s acids) and 5-benzyl-5-substituted Meldrum?s acids (quaternarized Meldrum?s acids), forming 1-indanones and 2-substituted-1-indanones respectively, are delineated. This method was further applied to the synthesis of 1-tetralones, 1-benzosuberones, and the potent acetylcholinesterase inhibitor donepezil. Mechanistic investigations were undertaken to determine the rate-determining step in the acylation sequence using Meldrum?s acid, as well as to examine the role of the Lewis acid catalyst. Enolizable Meldrum?s acid derivatives can react via an acyl ketene intermediate under thermal conditions, while quaternarized Meldrum?s acid derivatives are thermally stable and only act as effective Friedel-Crafts acylating agents in the presence of a Lewis acid catalyst. The total synthesis of (±)-Taiwaniaquinol B was completed. This natural product was the first ever isolated containing an unusual 6-5-6 fused ring system, and it also contains a hexasubstituted aromatic ring, and two all-carbon quaternary centers. This synthesis was accomplished via an intramolecular Friedel-Crafts acylation/carbonyl a-tert-alkylation reaction that exploits the unique chemistry of Meldrum?s acid. This novel methodology can be used to access a variety of highly substituted fused ring systems of various sizes

First observation of tool use in wild gorillas

Descriptions of novel tool use by great apes in response to different circumstances aids us in understanding the factors favoring the evolution of tool use in humans. This paper documents what we believe to be the first two observations of tool use in wild western gorillas(Gorilla gorilla). We first observed an adult female gorilla using a branch as a walking stick to test water deepness and to aid in her attempt to cross a pool of water at Mbeli Bai, a swampy forest clearing in northern Congo. In the second case we saw another adult female using a detached trunk from a small shrub as a stabilizer during food processing. She then used the trunk as a self-made bridge to cross a deep patch of swamp. In contrast to information from other great apes, which mostly show tool use in the context of food extraction, our observations show that in gorillas other factors such as habitat type can stimulate the use of tools

Triboelectric Effect Enabled Self-Powered, Point-of-Care Diagnostics: Opportunities for developing ASSURED and REASSURED devices

The use of rapid point-of-care (PoC) diagnostics in conjunction with physiological signal monitoring has seen tremendous progress in their availability and uptake, particularly in low- and middle-income countries (LMICs). However, to truly overcome infrastructural and resource constraints, there is an urgent need for self-powered devices which can enable on-demand and/or continuous monitoring of patients. The past decade has seen the rapid rise of triboelectric nanogenerators (TENGs) as the choice for high-efficiency energy harvesting for developing self-powered systems as well as for use as sensors. This review provides an overview of the current state of the art of such wearable sensors and end-to-end solutions for physiological and biomarker monitoring. We further discuss the current constraints and bottlenecks of these devices and systems and provide an outlook on the development of TENG-enabled PoC/monitoring devices that could eventually meet criteria formulated specifically for use in LMICs.Ulster Universityhttp://www.mdpi.com/journal/micromachineshj2021Electrical, Electronic and Computer Engineerin

Evolution and nucleosynthesis of asymptotic giant branch stellar models of low metallicity

We present stellar evolutionary tracks and nucleosynthetic predictions for a grid of stellar models of low- and intermediate-mass asymptotic giant branch (AGB) stars at Z = 0.001 ([Fe/H] =-1.2). The models cover an initial mass range from 1 M⊙ to 7 M