A retrospective study on the effects of illness severity and atrial fibrillation on outcomes in the intensive care unit

Introduction: Atrial fibrillation (AF) is common in patients in the intensive care unit (ICU) and has been associated with worse outcomes. However, it is unclear whether AF itself adds to the risk of death or is merely a marker of illness severity. We aimed to record the incidence and outcomes of all patients with different categories of AF and determine whether AF was an independent predictor of death.<p></p> Methods: This retrospective cohort study was undertaken in the ICU of a tertiary-referral university hospital. Category of AF, sex, C-reactive protein (CRP) level, APACHE II score, predicted hospital mortality and survival outcomes were analysed from 1084 records. Percentages, medians and interquartile ranges were used to describe the sample. Chi-square test and the non-parametric Mann–Whitney U test were used, as appropriate, for statistical analysis. Logistic regression analyses were performed to evaluate the association of AF with death in the ICU adjusting for age, sex, CRP level and APACHE II score.<p></p> Results: Overall, 13.6% of patients developed new-onset AF during their critical illness, while 4.3% had a pre-existing history. The hospital mortality rate was higher in those with AF compared with those without (47.9% vs. 30.9%, p<0.001) and higher in those with newly diagnosed AF compared with those with a prior history (53.1% vs. 31.9%, p=0.012). CRP levels were higher in those with AF (p<0.001) compared with those without and higher in those with newly diagnosed AF compared with those with a prior history (p=0.012). On multivariate logistic regression analysis, only the APACHE II score was found to be an independent predictor of death.<p></p> Conclusion: Despite the higher mortality rate in patients with AF, the APACHE II score was the only independent predictor of death within the ICU. Prospective studies are required to explore the apparently reduced risk of dying among those with a prior history of AF.<p></p&gt

Comfort women: The unrelenting oppression during and after WWII

Comfort women is a term used to describe approximately two-hundred thousand young women that were forced into sexual slavery. While the physical torture of the women ended after the war, the conflict over the government’s role in recognition and restitution of comfort women between the Japanese and the comfort women continues to be heated on both sides with little end in sight. By analyzing the testimonies, I explore the horrendous torture of the women by the Japanese army. Furthermore, the paper reveals the present-day struggles of these women for recognition and compensation. The plight of the comfort women will continue until the governments can come to an agreement on behalf of the women

Body weight and weight loss : are health messages reaching their target?

Objective: To investigate lay peoples&rsquo; knowledge of health risks of overweight, accuracy of self-perception of body weight and perceived benefits of weight loss. Method: A nine item questionnaire was administered to a cross sectional survey of adults in metropolitan shopping centres, height and weight were measured. Results: Two hundred and nine (57% female) adults completed the survey. Thirty eight percent had a healthy BMI (18.5-24.9), 38% were overweight (BMI 25-29.9) and a further 22% were obese (BMI&gt;30). However only 46% perceived themselves &lsquo;overweight&rsquo;, 50% considered themselves &lsquo;just about right&rsquo; and 4% considered themselves &lsquo;underweight&rsquo;. Of those with a BMI of 25 or greater 28% considered their weight &lsquo;just about right&rsquo;. Over 80% thought &lsquo;being overweight&rsquo; was &lsquo;likely&rsquo; or &lsquo;very likely&rsquo; to be a risk factor for cardiovascular disease, hypertension, diabetes and stroke; however 20% of overweight or obese individuals did not think their health would improve if they lost weight. Conclusion: A significant proportion of overweight or obese individuals do not accurately perceive their body weight and do not recognise the health advantages of weight loss despite recognising excess body weight as a risk factor for chronic diseases. Implications: Increasing the awareness of an individual&rsquo;s BMI and promoting the benefits of modest weight loss maybe two underutilized strategies for population level weight control.<br /

Cooling requirements fueled the collapse of a desert bird community from climate change.

Climate change threatens global biodiversity by increasing extinction risk, yet few studies have uncovered a physiological basis of climate-driven species declines. Maintaining a stable body temperature is a fundamental requirement for homeothermic animals, and water is a vital resource that facilitates thermoregulation through evaporative cooling, especially in hot environments. Here, we explore the potential for thermoregulatory costs to underlie the community collapse of birds in the Mojave Desert over the past century in response to climate change. The probability of persistence was lowest for species occupying the warmest and driest sites, which imposed the greatest cooling costs. We developed a general model of heat flux to evaluate whether water requirements for evaporative cooling contributed to species' declines by simulating thermoregulatory costs in the Mojave Desert for 50 bird species representing the range of observed declines. Bird species' declines were positively associated with climate-driven increases in water requirements for evaporative cooling and exacerbated by large body size, especially for species with animal-based diets. Species exhibiting reductions in body size across their range saved up to 14% in cooling costs and experienced less decline than species without size reductions, suggesting total cooling costs as a mechanism underlying Bergmann's rule. Reductions in body size, however, are unlikely to offset the 50 to 78% increase in cooling costs threatening desert birds from future climate change. As climate change spreads warm, dry conditions across the planet, water requirements are increasingly likely to drive population declines, providing a physiological basis for climate-driven extinctions

Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background

Background: Pain, both from the surgical site, and from other sources such as musculoskeletal backache, can persist after caesarean section. In this study of a predominantly socially deprived population we have sought to prospectively examine the association between antenatal maternal anxiety and socioeconomic background and the development of persistent pain of all sources after caesarean section. Methods: Demographic details and an anxiety questionnaire were completed by 205 women before elective caesarean section. On the first postoperative day, pain scores were recorded, and at four months patients were asked to complete a Brief Pain Inventory and an Edinburgh Postnatal Depression Score. Results: Of 205 parturients recruited, 186 records were complete at the hospital admission phase and 98 (52.7%) were complete at the four-month follow-up phase. At recruitment, 15.1% reported pain. At four months 41.8% (95% CI 32.1 to 51.6%) reported pain, of whom pain was a new finding in 35.7% (95% CI 26.2 to 45.2%). Antenatal anxiety was not a significant predictor of severity of new pain at four months (P=0.43 for state anxiety, P=0.52 for trait anxiety). However, four-month pain severity did correlate with social deprivation (P=0.011), postnatal depression (P&lt;0.001) and pain at 24 h (P=0.018). Conclusion: Persistent pain from a variety of sources after caesarean section is common. Our findings do not support the use of antenatal anxiety scoring to predict persistent pain in this setting, but suggest that persistent pain is influenced by acute pain, postnatal depression and socioeconomic deprivation