Lack of concentration-dependent local toxicity of highly concentrated (5%) versus conventional 0.5% bupivacaine following musculoskeletal surgery in a rat model

PURPOSE: Various sustained-release formulations incorporate high bupivacaine concentrations but data on local toxicity is lacking. This study explores local toxic effects of highly concentrated (5%) bupivacaine compared to clinically used concentrations in vivo following skeletal surgery, to assess the safety of sustained-release formulations with high bupivacaine concentrations. METHODS: Sixteen rats underwent surgery, in which screws with catheters affixed were implanted in the spine or femur in a factorial experimental design, allowing single-shot or continuous 72 h local administration of 0.5%, 2.5% or 5.0% bupivacaine hydrochloride. During the 30-day follow-up, animal weight was recorded and blood samples were obtained. Implantation sites underwent histopathological scoring for muscle damage, inflammation, necrosis, periosteal reaction/thickening and osteoblast activity. Effects of bupivacaine concentration, administration mode and implantation site on local toxicity scores were analyzed. RESULTS: Chi-squared tests for score frequencies revealed a concentration-dependent decrease in osteoblast count. Moreover, spinal screw implantation led to significantly more muscle fibrosis but less bone damage than femoral screw implantation, reflecting the more invasive muscle dissection and shorter drilling times related to the spinal procedure. No differences between bupivacaine administration modes regarding histological scoring or body weight changes were observed. Weight increased, while CK levels and leukocyte counts decreased significantly during follow-up, reflecting postoperative recovery. No significant differences in weight, leukocyte count and CK were found between interventional groups. CONCLUSION: This pilot study found limited concentration-dependent local tissue effects of bupivacaine solutions concentrated up to 5.0% following musculoskeletal surgery in the rat study population

Lack of concentration-dependent local toxicity of highly concentrated (5%) versus conventional 0.5% bupivacaine following musculoskeletal surgery in a rat model

PURPOSE: Various sustained-release formulations incorporate high bupivacaine concentrations but data on local toxicity is lacking. This study explores local toxic effects of highly concentrated (5%) bupivacaine compared to clinically used concentrations in vivo following skeletal surgery, to assess the safety of sustained-release formulations with high bupivacaine concentrations. METHODS: Sixteen rats underwent surgery, in which screws with catheters affixed were implanted in the spine or femur in a factorial experimental design, allowing single-shot or continuous 72 h local administration of 0.5%, 2.5% or 5.0% bupivacaine hydrochloride. During the 30-day follow-up, animal weight was recorded and blood samples were obtained. Implantation sites underwent histopathological scoring for muscle damage, inflammation, necrosis, periosteal reaction/thickening and osteoblast activity. Effects of bupivacaine concentration, administration mode and implantation site on local toxicity scores were analyzed. RESULTS: Chi-squared tests for score frequencies revealed a concentration-dependent decrease in osteoblast count. Moreover, spinal screw implantation led to significantly more muscle fibrosis but less bone damage than femoral screw implantation, reflecting the more invasive muscle dissection and shorter drilling times related to the spinal procedure. No differences between bupivacaine administration modes regarding histological scoring or body weight changes were observed. Weight increased, while CK levels and leukocyte counts decreased significantly during follow-up, reflecting postoperative recovery. No significant differences in weight, leukocyte count and CK were found between interventional groups. CONCLUSION: This pilot study found limited concentration-dependent local tissue effects of bupivacaine solutions concentrated up to 5.0% following musculoskeletal surgery in the rat study population

Qualitative study evaluating the expectations and experiences of Dutch parents of children with chronic gastrointestinal symptoms visiting their general practitioner

Objectives Chronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education are, therefore, key components of the physician’s management. Qualitative studies have shown how parents and children experience specialist paediatric care, yet less is known about general practitioners (GPs), who manage most cases in the Netherlands and have a more personal and enduring relationship with their patients. Therefore, this study evaluates the expectations and experiences of parents of children visiting a GP for chronic gastrointestinal symptoms.Design We conducted a qualitative interview study. Online interviews were audio and video recorded, transcribed verbatim and independently analysed by the first two authors. Data were collected and analysed concurrently until data saturation was reached. Using thematic analysis, we developed a conceptual framework reflecting respondent expectations and experiences. We performed a member check of the interview synopsis and the conceptual framework.Setting Dutch primary care.Participants We purposively sampled participants from a randomised controlled trial evaluating the effectiveness of faecal calprotectin testing in children with chronic gastrointestinal complaints in primary care. Thirteen parents and two children participated.Results Three key themes emerged: disease burden, GP–patient relationship and reassurance. Often, the experienced disease burden and the pre-existing GP–patient relationship influenced expectations (eg, for further investigations or a sympathetic ear), and when a GP fulfilled these expectations, a trusting GP–patient relationship ensued that facilitated reassurance. We found that individual needs influenced these themes and their interrelationships.Conclusion Insights provided by this framework could help GPs managing children with chronic gastrointestinal symptoms in daily practice and may therewith improve the consultation experience for parents. Further research should evaluate whether this framework also holds true for children.Trial registration number NL7690

LOFAR and APERTIF Surveys of the Radio Sky : Probing Shocks and Magnetic Fields in Galaxy Clusters

At very low frequencies, the new pan-European radio telescope LOFAR is opening the last unexplored window of the electromagnetic spectrum for astrophysical studies. The revolutionary APERTIF-phased arrays that are about to be installed on the Westerbork radio telescope (WSRT) will dramatically increase the survey speed for the WSRT. Combined surveys with these two facilities will deeply chart the northern sky over almost two decades in radio frequency from similar to 15 up to 1400 MHz. Here we briefly describe some of the capabilities of these new facilities and what radio surveys are planned to study fun-damental issues related to the formation and evolution of galaxies and clusters of galaxies. In the second part we briefly review some recent observational results directly showing that diffuse radio emission in clusters traces shocks due to cluster mergers. As these diffuse radio sources are relatively bright at low frequencies, LOFAR should be able to detect thousands of such sources up to the epoch of cluster formation. This will allow addressing many question about the origin and evolution of shocks and magnetic fields in clusters. At the end we briefly review some of the first and very preliminary LOFAR results on clusters.Peer reviewe

Does theatre improve the quality of life of people with dementia?

Background: A new communication method, the "Veder method", has recently been developed. Caregivers are trained to apply this method in a group activity ("living-room theatre activity") for people with dementia in which theatrical stimuli are used in combination with proven emotion-oriented care methods. The aim of this exploratory study was to evaluate the added value of the Veder method group activity compared to a regular reminiscence group activity and to investigate whether professional carers can achieve the same effects with the Veder method as professional actors. Methods: A quasi-experimental three-group design was used. Experimental group 1 (E1; n = 65) joined a living-room theatre activity offered by trained professional caregivers. Experimental group 2 (E2; n = 31) joined a living-room theatre activity offered by professional actors. The control group (n = 55) received a usual reminiscence group activity. Behavior, mood and aspects of quality of life were measured using standardized observation scales at three points in time: (T1) pretest; (T2) during the intervention and; (T3) post-test, two hours after the intervention. Results: During the intervention, significant differences were found in favor of the group that was offered a living-room theatre activity by actors (E2) on different aspects of behavior, mood and quality of life. At post-test, people in E2 were more alert compared to the control group. Moreover, they recalled more memories and showed less socially isolated behavior compared to the control group. Conclusion: This exploratory study shows that the Veder method has some clear positive effects on behavior and mood of people with dementia when applied by professional actors

Lack of concentration-dependent local toxicity of highly concentrated (5%) versus conventional 0.5% bupivacaine following musculoskeletal surgery in a rat model

PURPOSE: Various sustained-release formulations incorporate high bupivacaine concentrations but data on local toxicity is lacking. This study explores local toxic effects of highly concentrated (5%) bupivacaine compared to clinically used concentrations in vivo following skeletal surgery, to assess the safety of sustained-release formulations with high bupivacaine concentrations. METHODS: Sixteen rats underwent surgery, in which screws with catheters affixed were implanted in the spine or femur in a factorial experimental design, allowing single-shot or continuous 72 h local administration of 0.5%, 2.5% or 5.0% bupivacaine hydrochloride. During the 30-day follow-up, animal weight was recorded and blood samples were obtained. Implantation sites underwent histopathological scoring for muscle damage, inflammation, necrosis, periosteal reaction/thickening and osteoblast activity. Effects of bupivacaine concentration, administration mode and implantation site on local toxicity scores were analyzed. RESULTS: Chi-squared tests for score frequencies revealed a concentration-dependent decrease in osteoblast count. Moreover, spinal screw implantation led to significantly more muscle fibrosis but less bone damage than femoral screw implantation, reflecting the more invasive muscle dissection and shorter drilling times related to the spinal procedure. No differences between bupivacaine administration modes regarding histological scoring or body weight changes were observed. Weight increased, while CK levels and leukocyte counts decreased significantly during follow-up, reflecting postoperative recovery. No significant differences in weight, leukocyte count and CK were found between interventional groups. CONCLUSION: This pilot study found limited concentration-dependent local tissue effects of bupivacaine solutions concentrated up to 5.0% following musculoskeletal surgery in the rat study population

Perspectives on the future of nature in Europe: storylines and visualisations : background report

Throughout Europe, people experience and value nature in various ways, but they also experience the decline in biological diversity. Although successes have been achieved, nature policies have not been effective in all respects. Halting biodiversity loss and restoring ecological systems in the EU requires substantial action, in addition to current measures implemented under the EU Birds and Habitats Directives. More effective implementation, more coherence with other policies and greater engagement by other sectors and the public are needed. A closer connection between the ways in which people experience and value nature and nature policy may enhance their engagement in nature-related efforts. A more fundamental reflection on nature policies may be helpful. This has been done by PBL in its Nature Outlook study, which presents alternative ‘perspectives’ on the future of nature in the European Union. The synthesis report European nature in the plural1 is primarily intended to provide inspiration for current strategic discussions on EU policies that are related to nature beyond 2020, whereas the current report provides complete versions of the storylines and visualisations of the perspectives. Thereby, it enables policymakers and stakeholders to derive more specific insights and ideas from the perspectives. The report may be used to generate insights for policies, facilitate communication and boost engagement in nature among other sectors and citizens. In order to stimulate this, the report explains how policymakers and stakeholders could use the perspectives to create joint visions. The Nature Outlook project consists of a baseline, a trend scenario, four perspectives and several policy messages. These components have been constructed not only from literature review and visualisations, but also by using the results from a philosophers’ dialogue on the relationships between people and nature in Europe, as well as several stakeholder dialogues on the future of nature

European nature in the plural : finding common ground for a next policy agenda

European landscapes contain a rich natural diversity that is cherished by many citizens. Protection of this diversity is laid down in policy strategies on European and national levels. Nevertheless, a recent review of the EU Biodiversity Strategy showed that additional efforts are needed to achieve the targets for 2020. Even more effort is required to realise the 2050 vision – which is to protect, value and restore EU biodiversity and the ecosystem services it provides. People consider ‘nature’ to constitute landscapes, ecosystems and biodiversity. Recent reviews and trend analyses have shown there to be three overall challenges for the coming decades, with respect to nature conservation: ensuring sufficient space and favourable conditions for nature, improving nature considerations in economic sectors, and encouraging people’s engagement in naturerelated efforts. For this study, we explored four ‘perspectives’ on nature in 2050, with the aim to inform a future agenda for nature policies beyond 2020. The rationale behind working with perspectives is that broadening the concept of nature may lead to greater citizen and business engagement in efforts that would benefit nature. The perspectives on nature cover a range of guiding values about nature protection and describe what people perceive to be nature: In Strengthening Cultural Identity, people feel connected with nature and landscape, and consider this an integral part of their local and regional communities and essential to a fulfilling life. In Allowing Nature to Find its Way, people feel strongly about the great intrinsic value of natural processes and species, and they define nature by its dynamic processes and believe it should be left to its own devices. In Going with the Economic Flow, nature must suit people’s lifestyles, and businesses and individual citizens take the initiative in nature development. In Working with Nature, people try to work with natural processes and strive for an optimal, long-term delivery of ecosystem services, for the benefit of both society and the economy

LOFAR: Recent Imaging Results and Future Prospects

The Low-Frequency Array (LOFAR) is under construction in the Netherlands and in several surrounding European countries. In this contribution, we describe the layout and design of the telescope, with particular emphasis on the imaging characteristics of the array when used in its 'standard imaging' mode. After briefly reviewing the calibration and imaging software used for LOFAR image processing, we show some recent results from the ongoing imaging commissioning efforts. We conclude by summarizing future prospects for the use of LOFAR in observing the little-explored low-frequency Universe