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

Animal cultures matter for conservation

This is the author accepted manuscript. The final version is available from AAAS via the DOI in this record.No abstrac

Animal cultures matter for conservation

Understanding the rich social lives of animals benefits international conservation efforts.PostprintPeer reviewe

Food insecurity as a pediatric health concern

Campbell, DellaPurpose: The purpose of this Doctor of Nursing Practice (DNP) project was to implement food insecurity (FI) screening and community resource referral during non-acute pediatric emergency room visits. Background and Review of Literature: FI is defined as inadequate access to nutritious food due to financial or other constraints. In 2016, over 15 million American children lived in food insecure households. Pediatric FI sequelae include neurocognitive, developmental and physical impairments. Effective FI screening and referral protocols may promote earlier identification and enrollment with services. Systematic literature review of FI screening in Cochrane, Medline, PubMed, and Scopus databases produced 1,775 peer-reviewed articles published since 2013. Of these, 28 studies met inclusion criteria of English language and pediatric ambulatory environments. Methods: A FI screening protocol was established in a pediatric tertiary hospital emergency department. A two-item validated tool was integrated into the electronic health record (EHR) and staff performed screening of clinically stable children and families. A diagnosis of FI was added to the EHR to promote monitoring across health disciplines and social work consulted for urgent unmet needs. An English and Spanish regional food resource brochure was distributed. Eighty families were contacted retrospectively 30 days post discharge to ascertain perceptions of the screening process and to determine their connection rate to food services. Results: Over eight weeks, ED staff conducted 6151 FI screens, of which 117 were positive (1.9%). Telephone follow-up was completed with 80 families. Of these, 96.25 % had accessed one FI resource, 72.7% had accessed two or more services. Conclusions: Professional staff in a pediatric ED successfully developed and deployed a FI screening measure during an eight-week trial. Follow-up of those screened positive showed that they used the resources provided. Limitations included face to face social determinant screening methodologies, and truncated time period allocated for project. Still, the protocol holds promise for providing early intervention for FI, enabling children and their families to restore nutritional health. Insufficient literature existed to determine the ideal methods of successfully connecting patients to services. ☐ Keywords: Combinations with Boolean operators ’food’, ‘security’, insecurity’, ‘intervention’, ‘hunger’, ‘screening’, ‘pediatric’, ‘children’, ‘adolescent’, ambulatoryUniversity of Delaware, School of NursingD.N.P

Evidence for a macromolecular complex in poor prognosis CLL that contains CD38, CD49d, CD44 and MMP-9

International audienceProgressive chronic lymphocytic leukaemia is characterised by the accumulation of neoplastic B-cells in the tissues and correlates with the expression of prognostic biomarkers such as CD38, CD49d and matrix metalloproteinase-9 (MMP9), which are involved in migration and tissue invasion. In this study we investigated the physical relationship between these molecules and demonstrate that CD38, CD49d, MMP9 and CD44 are physically associated in a supramolecular cell surface complex. Our findings provide a molecular basis for the correlation between expression of these proteins and prognosis and, since the complex is not present in normal B-cells, suggest a novel leukaemia-specific therapeutic target

A deepening understanding of animal culture suggests lessons for conservation

Funding and support as follows: Whale and Dolphin Conservation to P.B.; Royal Society New Zealand Rutherford Discovery Fellowship to E.L.C; Radcliffe Fellowship, Radcliffe Institute for Advanced Study, Harvard University, and Biotechnology and Biological Sciences Research Council grant no. [BB/S018484/1]to C.R.; Human Frontier Science Program grant no. [RGP00049] to A.T.; Royal Society University Research Fellowship grant no. [UF160081] to E.C.G.A key goal of conservation is to protect biodiversity by supporting the long-term persistence of viable, natural populations of wild species. Conservation practice has long been guided by genetic, ecological and demographic indicators of risk. Emerging evidence of animal culture across diverse taxa and its role as a driver of evolutionary diversification, population structure and demographic processes may be essential for augmenting these conventional conservation approaches and decision-making. Animal culture was the focus of a ground-breaking resolution under the Convention on the Conservation of Migratory Species of Wild Animals (CMS), an international treaty operating under the UN Environment Programme. Here, we synthesise existing evidence to demonstrate how social learning and animal culture interact with processes important to conservation management. Specifically, we explore how social learning might influence population viability, be an important resource in response to anthropogenic change and provide examples of how it can result in phenotypically distinct units with different, socially learnt behavioural strategies. Whilst identifying culture and social learning can be challenging, indirect identification and parsimonious inferences may be informative. Finally, we identify relevant methodologies and provide a framework for viewing behavioural data through a cultural lens which might provide new insights for conservation management.Publisher PDFPeer reviewe