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

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

A Very Intense Neutrino Super Beam Experiment for Leptonic CP Violation Discovery based on the European Spallation Source Linac: A Snowmass 2013 White Paper

Very intense neutrino beams and large neutrino detectors will be needed in order to enable the discovery of CP violation in the leptonic sector. We propose to use the proton linac of the European Spallation Source currently under construction in Lund, Sweden to deliver, in parallel with the spallation neutron production, a very intense, cost effective and high performance neutrino beam. The baseline program for the European Spallation Source linac is that it will be fully operational at 5 MW average power by 2022, producing 2 GeV 2.86 ms long proton pulses at a rate of 14 Hz. Our proposal is to upgrade the linac to 10 MW average power and 28 Hz, producing 14 pulses/s for neutron production and 14 pulses/s for neutrino production. Furthermore, because of the high current required in the pulsed neutrino horn, the length of the pulses used for neutrino production needs to be compressed to a few $\mu$s with the aid of an accumulator ring. A long baseline experiment using this Super Beam and a megaton underground Water Cherenkov detector located in existing mines 300-600 km from Lund will make it possible to discover leptonic CP violation at 5 $\sigma$ significance level in up to 50% of the leptonic Dirac CP-violating phase range. This experiment could also determine the neutrino mass hierarchy at a significance level of more than 3 $\sigma$ if this issue will not already have been settled by other experiments by then. The mass hierarchy performance could be increased by combining the neutrino beam results with those obtained from atmospheric neutrinos detected by the same large volume detector. This detector will also be used to measure the proton lifetime, detect cosmological neutrinos and neutrinos from supernova explosions. Results on the sensitivity to leptonic CP violation and the neutrino mass hierarchy are presented.Comment: 28 page

Effects of Pre-Cutting Round Alfalfa Hay Bales on Forage Quality and Processing Time

Round hay balers with knives that cut the hay as it enters the baling chamber reduce the particle size upon baling, and eliminate the need for a tub grinder. The objective of this study was to evaluate the effects of a round hay baler with knives on forage quality of alfalfa hay at baling and after storage, and the effects of the processing method on nutrient composition and particle size distribution. Alfalfa hay was baled (560 M Megawide HC2, John Deere, Moline, IL) with knives every 4 inches (CUT; theo­retical length of cut) or without knives (NORM). At baling and after 6 months of uncovered storage, bales were weighed, measured, and 10 core samples were obtained for nutrient analysis. Cores were separated into outer 6 inches and inner 6- to 18-inch segments to determine the depth of spoilage. After storage, particle size was reduced to approximately 4 inches using a mixer wagon for CUT (CUT-MIX) or a tub grinder for NORM (NORM-GRIND). Compared with NORM, CUT increased bale weight and density. Core depth interacted with storage timepoint whereby acid detergent fiber (ADF) concentration increased more for outer than inner cores from baling to the end of storage, with similar effects for lignin and 240-hour undigest­ible NDF. Compared with NORM, CUT increased concentrations of aNDF organic matter, ADF, and lignin, and decreased relative forage quality (RFQ). The CUT-MIX treatment increased time to reduce particle size, but decreased processing shrink by 6.1% compared with NORM-GRIND. Additionally, when compared with NORM-GRIND, CUT-MIX increased fiber content and decreased fiber digestibility, which may have been due to sampling error from longer particle size. In summary, CUT produced larger, more dense bales and increased fiber content slightly, and CUT-MIX decreased processing shrink but increased fiber content with additional longer particles after processing, which could be advantageous for physically effective fiber in ruminant diets. Further work should continue to evaluate leaf loss during baling, and options for processing and incorporating pre-cut hay into diets

Precision measurements of the total and partial widths of the psi(2S) charmonium meson with a new complementary-scan technique in antiproton-proton annihilations

We present new precision measurements of the psi(2S) total and partial widths from excitation curves obtained in antiproton-proton annihilations by Fermilab experiment E835 at the Antiproton Accumulator in the year 2000. A new technique of complementary scans was developed to study narrow resonances with stochastically cooled antiproton beams. The technique relies on precise revolution-frequency and orbit-length measurements, while making the analysis of the excitation curve almost independent of machine lattice parameters. We study the psi(2S) meson through the processes pbar p -> e+ e- and pbar p -> J/psi + X -> e+ e- + X. We measure the width to be Gamma = 290 +- 25(sta) +- 4(sys) keV and the combination of partial widths Gamma_e+e- * Gamma_pbarp / Gamma = 579 +- 38(sta) +- 36(sys) meV, which represent the most precise measurements to date.Comment: 17 pages, 3 figures, 3 tables. Final manuscript accepted for publication in Phys. Lett. B. Parts of the text slightly expanded or rearranged; results are unchange

Developing a pressure ulcer risk factor minimum data set and risk assessment framework

AIM: To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BACKGROUND: A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DESIGN: Consensus study.METHOD: A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.FINDINGS: The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.CONCLUSION: The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework

CSI 2264: Accretion process in classical T Tauri stars in the young cluster NGC 2264

Context. NGC 2264 is a young stellar cluster (~3 Myr) with hundreds of low-mass accreting stars that allow a detailed analysis of the accretion process taking place in the pre-main sequence. Aims. Our goal is to relate the photometric and spectroscopic variability of classical T Tauri stars to the physical processes acting in the stellar and circumstellar environment, within a few stellar radii from the star. Methods. NGC 2264 was the target of a multiwavelength observational campaign with CoRoT, MOST, Spitzer, and Chandra satellites and photometric and spectroscopic observations from the ground. We classified the CoRoT light curves of accreting systems according to their morphology and compared our classification to several accretion diagnostics and disk parameters. Results. The morphology of the CoRoT light curve reflects the evolution of the accretion process and of the inner disk region. Accretion burst stars present high mass-accretion rates and optically thick inner disks. AA Tau-like systems, whose light curves are dominated by circumstellar dust obscuration, show intermediate mass-accretion rates and are located in the transition of thick to anemic disks. Classical T Tauri stars with spot-like light curves correspond mostly to systems with a low mass-accretion rate and low mid-IR excess. About 30% of the classical T Tauri stars observed in the 2008 and 2011 CoRoT runs changed their light-curve morphology. Transitions from AA Tau-like and spot-like to aperiodic light curves and vice versa were common. The analysis of the Hα emission line variability of 58 accreting stars showed that 8 presented a periodicity that in a few cases was coincident with the photometric period. The blue and red wings of the Hα line profiles often do not correlate with each other, indicating that they are strongly influenced by different physical processes. Classical T Tauri stars have a dynamic stellar and circumstellar environment that can be explained by magnetospheric accretion and outflow models, including variations from stable to unstable accretion regimes on timescales of a few years

Electrons in the Young Solar Wind: First Results from the Parker Solar Probe

The Solar Wind Electrons Alphas and Protons experiment on the Parker Solar Probe (PSP) mission measures the three-dimensional electron velocity distribution function. We derive the parameters of the core, halo, and strahl populations utilizing a combination of fitting to model distributions and numerical integration for $\sim 100,000$ electron distributions measured near the Sun on the first two PSP orbits, which reached heliocentric distances as small as $\sim 0.17$ AU. As expected, the electron core density and temperature increase with decreasing heliocentric distance, while the ratio of electron thermal pressure to magnetic pressure ($\beta_e$) decreases. These quantities have radial scaling consistent with previous observations farther from the Sun, with superposed variations associated with different solar wind streams. The density in the strahl also increases; however, the density of the halo plateaus and even decreases at perihelion, leading to a large strahl/halo ratio near the Sun. As at greater heliocentric distances, the core has a sunward drift relative to the proton frame, which balances the current carried by the strahl, satisfying the zero-current condition necessary to maintain quasi-neutrality. Many characteristics of the electron distributions near perihelion have trends with solar wind flow speed, $\beta_e$, and/or collisional age. Near the Sun, some trends not clearly seen at 1 AU become apparent, including anti-correlations between wind speed and both electron temperature and heat flux. These trends help us understand the mechanisms that shape the solar wind electron distributions at an early stage of their evolution

CSI 2264 : accretion process in classical T Tauri stars in the young cluster NGC 2264

APS and SHPA acknowledge support from CNPq, CAPES and Fapemig. JFG acknowledges support from FCT ref project UID/FIS/04434/2013.Context. NGC 2264 is a young stellar cluster (~3 Myr) with hundreds of low-mass accreting stars that allow a detailed analysis of the accretion process taking place in the pre-main sequence. Aims. Our goal is to relate the photometric and spectroscopic variability of classical T Tauri stars to the physical processes acting in the stellar and circumstellar environment, within a few stellar radii from the star. Methods. NGC 2264 was the target of a multiwavelength observational campaign with CoRoT, MOST, Spitzer, and Chandra satellites and photometric and spectroscopic observations from the ground. We classified the CoRoT light curves of accreting systems according to their morphology and compared our classification to several accretion diagnostics and disk parameters. Results. The morphology of the CoRoT light curve reflects the evolution of the accretion process and of the inner disk region. Accretion burst stars present high mass-accretion rates and optically thick inner disks. AA Tau-like systems, whose light curves are dominated by circumstellar dust obscuration, show intermediate mass-accretion rates and are located in the transition of thick to anemic disks. Classical T Tauri stars with spot-like light curves correspond mostly to systems with a low mass-accretion rate and low mid-IR excess. About 30% of the classical T Tauri stars observed inthe 2008 and 2011 CoRoT runs changed their light-curve morphology.Transitions from AA Tau-like and spot-like to a periodic light curves and vice versa were common. The analysis of the Hα emission line variability of 58 accreting stars showed that 8 presented a periodicity that in a few cases was coincident with the photometric period. The blue and red wings of the Hα line profiles often do not correlate with each other, indicating that they are strongly influenced by different physical processes. Classical T Tauri stars have a dynamic stellar and circumstellar environment that can be explained by magnetospheric accretion and outflow models, including variations from stable to unstable accretion regimes on timescales of a few years.PostprintPeer reviewe

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

This is the final version. Available from NIHR Journals Library via the DOI in this record.Background Pain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed. Aims and objectives Two studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals. Methods For the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four carers, informal conversations with staff and carers and analysis of ward documents and policies. Thematic analysis of the data was undertaken by the project team. Results Data from eight systematic reviews including 28 tools were included in the meta-review. Most tools showed moderate to good reliability, but information about validity, feasibility and clinical utility was scarce. The observational study showed complex ward cultures and routines, with variations in time spent with patients, communication patterns and management practices. Carer involvement was rare. No pain decision support tools were observed in practice. Information about pain was elicited in different ways, at different times, by different health-care staff and recorded in separate documents. Individual staff made sense of patients’ pain by creating their own ‘overall picture’ from available information. Limitations Grey literature and non-English-language papers were excluded from the meta-review. Sample sizes in the observational study were smaller than planned owing to poor documentation of patients’ dementia diagnoses, gatekeeping by staff and difficulties in gaining consent/assent. Many patients had no or geographically distant carers, or a spouse who was too unwell and/or reluctant to participate. Conclusions No single observational pain scale was clearly superior to any other. The traditional linear concept of pain being assessed, treated and reassessed by single individuals did not ‘fit’ with clinical reality. A new approach enabling effective communication among patients, carers and staff, centralised recording of pain-related information, and an extended range of pain management interventions is proposed [Pain And Dementia Decision Support (PADDS)]. This was not tested with users, but a follow-on study aims to codesign PADDS with carers and clinicians, then introduce education on staff/patient/carer communications and use of PADDS within a structured implementation plan. PADDS will need to be tested in differing ward contexts.National Institute for Health Research Health Services and Delivery Research programm