Pressure ulcer related pain in community populations: a prevalence survey.

BACKGROUND: Pressure ulcers are costly to the healthcare provider and can have a major impact on patient's quality of life. One of the most distressing symptoms reported is pain. There is very little published data on the prevalence and details of pain experienced by patients with pressure ulcers, particularly in community populations. The study was conducted in two community NHS sites in the North of England. METHODS: The aim was to estimate the prevalence of pressure area related pain within a community population. We also explored the type and severity of the pain and its association with pressure ulcer classification. A cross-sectional survey was performed of community nurses caseloads to identify adult patients with pressure ulcers and associated pain. Consenting patients then had a full pain assessment and verification of pressure ulcer grade. RESULTS: A total of 287 patients were identified with pressure ulcers (0.51 per 1000 adult population). Of the 176 patients who were asked, 133 (75.6%) reported pain. 37 patients consented to a detailed pain assessment. Painful pressure ulcers of all grades and on nearly all body sites were identified. Pain intensity was not related to number or severity of pressure ulcer. Both inflammatory and neuropathic pain were reported at all body sites however the proportion of neuropathic pain was greater in pressure ulcers on lower limbs. CONCLUSIONS: This study has identified the extent and type of pain suffered by community patients with pressure ulcers and indicates the need for systematic and regular pain assessment and treatment

Space shuttle: High angle of attack transition and low angle of attack launch phase aerodynamic stability and control of GD/C B-18E-2, B-18E-3 delta wing booster, and launch configuration of MSC-040A orbiter and twin pressure fed boosters

The test was a conventional stability and control test except for two aspects. One was the very high angles of attack at which the delta wing configurations were tested (up to 60 degrees) at Mach numbers of 3 and 4.96. The other was the installation of the orbiter and twin boosters in a manner that caused the support system to induce normal forces and side forces on the aft portion of the boosters at all Mach numbers; i.e., the support and the booster bodies were close together, side by side

Space shuttle: Longitudinal and lateral aerodynamic characteristics of the 0.0035-scale GD/C aerospace booster (B-15B-1)

Force tests on a 0.0035-scale model of the General Dynamics/Convair space shuttle B-15B-1 booster were conducted in the MSFC trisonic wind tunnel during February and March 1971. Longitudinal and lateral characteristics were obtained at Mach numbers from 0.6 to 4.96. The configuration tested had a low delta wing, all-movable canard controls of delta planform, and a single vertical tail. Most of the test was devoted to obtaining data relevant to the transition from atmospheric reentry to subsonic cruise. In that portion of the test the angles of attack ranged from 6 degrees to 60 degrees, and yaw runs were made at angles of attack of 15 and 35 degrees. The rest of the test was devoted to obtaining booster-alone buildup data relevant to the launch phase. For the launch phase, the Mach number range was from 0.6 to 2.0, the angles of attack were from -10 to +10 degrees, and yaw runs were made at zero angle of attack

Dispersed methane flux to the water column from natural gas bubble streams at the Black Sea shelf

Gas bubble streams are detected in the water column by the presence of strong, flare shaped backscatter signals recorded during hydroacoustic single beam echosounder surveys (flares). Some of these flares even reach the sea surface. In motion bubbles get into an evolutionary process caused by a variety of effects, including gaseous exchange with surrounding water. Simplistically, kinetics of such a gas exchange can be described by the Fick’s law; the direction of the transfer of any given gas through the bubble depends on partial pressure of respective the gas in bubble, Henry’s law constants and the concentration of dissolved gas in the water. In general, methane gradually dissolves during the lifetime of a bubble, while other gases enter the bubble. Consequently, bubbles cause a vertical transfer of methane from the sea bottom to upper water layers and can be considered as sources of dispersed methane flux to the water column. In present work an attempt is made to trace the methane gas phase exhaustion in flares trough the water column at the Black Sea shelf.Our approach is based upon acoustic observations and measurements carried out in 2003 and 2004 with the scientific echosounder EK-500 onboard RV Vodianitskiy as part of the EU funded project CRIMEA. For the estimation of bubble size distributions our data from direct measurements of acoustic cross-section of single bubbles were used. Data for the relation between rising speed and shrinking rate vs. bubble size were obtained by tracking of single bubbles. Modelling was used to evaluate features of the gas transfer process induced by rising bubbles. Having initial bubble size, gas composition and water depth as starting conditions the model produces series of time based values of bubble size, gas composition, rising depth and rising speed. Acoustic observations were utilized to verify the chosen model parameters.For seeps detected at 90 - 95 m water depth hydroacoustically measured bubble sizes ranged from 1.3 to 11.3 mm in diameter. This bubble size range was confirmed by visual observations during video and submersible inspections.We assumed a gas content of 99% methane and small amounts of nitrogen and oxygen as initial gas composition according to geochemical analyses of gas bubbles sampled by submersible just above the sea floor. To determine the entire free methane flux from the sea floor into the water column and maybe into the atmosphere we run our model for several bubble sizes classes. Then simulation data were summed up with weighting coefficients according to the respective amount of bubbles per class. As a result, vertical profiles of molar content (mkmol) and methane flux (mkmol/s m) per average statistic bubble vs. depth were obtained. To get methane flux from the whole seepage simple multiplication is required by average statistic initial number of bubbles above the bottom per unit height. Depending on the spatial extension of the seep area, point or volume backscattering methods were used to quantify the bubble amount. Of great importance for both methods is the averaging of a high amount of data in space and time. We detected an average of 400 bubbles at high intensity seep sites within a water volume of 1m thickness above the bottom. The hydroacoustically determined amount of bubbles is again in very good agreement with direct visual observations. With an average initial rising speed of 0.25 m/s, 400 bubbles escaping from the sea floor cause a methane flux of 3.45 mmol/s using average bubble methane content of 34.5 mkmol (400 x 0.25 x 34.5 = 3.45 mmol/s). As final methane content of average bubble at the sea surface is 6.5 mkmol, only 6.5/34.5*100 = 18.8 % of methane can reach the atmosphere due to the methane flux into the water column on the way up to the sea surface

Changes in epithelial proportions and transcriptional state underlie major premenopausal breast cancer risks

The human breast undergoes lifelong remodeling in response to estrogen and progesterone, but hormone exposure also increases breast cancer risk. Here, we use single-cell analysis to identify distinct mechanisms through which breast composition and cell state affect hormone signaling. We show that prior pregnancy reduces the transcriptional response of hormone-responsive (HR+) epithelial cells, whereas high body mass index (BMI) reduces overall HR+ cell proportions. These distinct changes both impact neighboring cells by effectively reducing the magnitude of paracrine signals originating from HR+ cells. Because pregnancy and high BMI are known to protect against hormone-dependent breast cancer in premenopausal women, our findings directly link breast cancer risk with person-to-person heterogeneity in hormone responsiveness. More broadly, our findings illustrate how cell proportions and cell state can collectively impact cell communities through the action of cell-to-cell signaling networks

Motivation as a predictor of outcomes in school-based humanistic counselling

Recent years have seen a growth in the provision of counselling within UK secondary schools, and research indicates that it is associated with significant reductions in psychological distress. However, little is known about the moderators and mediators of positive therapeutic benefit. In the field of adult mental health, motivation has been found to be one of the strongest predictors of therapeutic outcomes, and it was hypothesised that this may also be a predictor of outcomes for young people in school-based counselling services. To assess the relationship between young people’s motivation for counselling and its effectiveness within a secondary school setting. Eighty-one young people (12 - 17 years old) who attended school-based humanistic counselling services in Scotland. Clients completed a measure of motivation for counselling at the commencement of their therapeutic work and a measure of psychological wellbeing at the commencement and termination of counselling. Motivation for counselling was not found to be significantly related to outcomes. The results indicate that the association between motivation and outcomes may be weaker in young people as compared with adults. However, a number of design factors may also account for the non-significant findings: insufficient participants, marginal reliability of the motivation measure and social desirability effects

Sequence alignment, mutual information, and dissimilarity measures for constructing phylogenies

Existing sequence alignment algorithms use heuristic scoring schemes which cannot be used as objective distance metrics. Therefore one relies on measures like the p- or log-det distances, or makes explicit, and often simplistic, assumptions about sequence evolution. Information theory provides an alternative, in the form of mutual information (MI) which is, in principle, an objective and model independent similarity measure. MI can be estimated by concatenating and zipping sequences, yielding thereby the "normalized compression distance". So far this has produced promising results, but with uncontrolled errors. We describe a simple approach to get robust estimates of MI from global pairwise alignments. Using standard alignment algorithms, this gives for animal mitochondrial DNA estimates that are strikingly close to estimates obtained from the alignment free methods mentioned above. Our main result uses algorithmic (Kolmogorov) information theory, but we show that similar results can also be obtained from Shannon theory. Due to the fact that it is not additive, normalized compression distance is not an optimal metric for phylogenetics, but we propose a simple modification that overcomes the issue of additivity. We test several versions of our MI based distance measures on a large number of randomly chosen quartets and demonstrate that they all perform better than traditional measures like the Kimura or log-det (resp. paralinear) distances. Even a simplified version based on single letter Shannon entropies, which can be easily incorporated in existing software packages, gave superior results throughout the entire animal kingdom. But we see the main virtue of our approach in a more general way. For example, it can also help to judge the relative merits of different alignment algorithms, by estimating the significance of specific alignments.Comment: 19 pages + 16 pages of supplementary materia

Altered functional connectivity in lesional peduncular hallucinosis with REM sleep behavior disorder

Brainstem lesions causing peduncular hallucinosis (PH) produce vivid visual hallucinations occasionally accompanied by sleep disorders. Overlapping brainstem regions modulate visual pathways and REM sleep functions via gating of thalamocortical networks. A 66-year-old man with paroxysmal atrial fibrillation developed abrupt–onset complex visual hallucinations with preserved insight and violent dream enactment behavior. Brain MRI showed restricted diffusion in the left rostrodorsal pons suggestive of an acute ischemic stroke. REM sleep behavior disorder (RBD) was diagnosed on polysomnography. We investigated the integrity of ponto-geniculate-occipital circuits with seed-based resting-state functional connectivity MRI (rs-fcMRI) in this patient compared to 46 controls. Rs-fcMRI revealed significantly reduced functional connectivity between the lesion and lateral geniculate nuclei (LGN), and between LGN and visual association cortex compared to controls. Conversely, functional connectivity between brainstem and visual association cortex, and between visual association cortex and prefrontal cortex (PFC) was significantly increased in the patient. Focal damage to the rostrodorsal pons is sufficient to cause RBD and PH in humans, suggesting an overlapping mechanism in both syndromes. This lesion produced a pattern of altered functional connectivity consistent with disrupted visual cortex connectivity via de-afferentation of thalamocortical pathways

Mechanisms Underlying Age- and Performance-related Differences in Working Memory

This study took advantage of the subsecond temporal resolution of ERPs to investigate mechanisms underlying age- and performance-related differences in working memory. Young and old subjects participated in a verbal n-back task with three levels of difficulty. Each group was divided into high and low performers based on accuracy under the 2-back condition. Both old subjects and low-performing young subjects exhibited impairments in preliminary mismatch/match detection operations (indexed by the anterior N2 component). This may have undermined the quality of information available for the subsequent decision-making process (indexed by the P3 component), necessitating the appropriation of more resources. Additional anterior and right hemisphere activity was recruited by old subjects. Neural efficiency and the capacity to allocate more resources to decision-making differed between high and low performers in both age groups. Under low demand conditions, high performers executed the task utilizing fewer resources than low performers (indexed by the P3 amplitude). As task requirements increased, high-performing young and old subjects were able to appropriate additional resources to decision-making, whereas their low-performing counterparts allocated fewer resources. Higher task demands increased utilization of processing capacity for operations other than decision-making (e.g., sustained attention) that depend upon a shared pool of limited resources. As demands increased, all groups allocated additional resources to the process of sustaining attention (indexed by the posterior slow wave). Demands appeared to have exceeded capacity in low performers, leading to a reduction of resources available to the decision-making process, which likely contributed to a decline in performance