Neuropsychiatric disorders among Syrian and Iraqi refugees in Jordan: A retrospective cohort study 2012-2013

Background: The burden of neuropsychiatric disorders in refugees is likely high, but little has been reported on the neuropsychiatric disorders that affect Syrian and Iraqi refugees in a country of first asylum. This analysis aimed to study the cost and burden of neuropsychiatric disorders among refugees from Syria and Iraq requiring exceptional, United Nations-funded care in a country of first asylum. Methods: The United Nations High Commissioner for Refugees works with multi-disciplinary, in-country exceptional care committees to review refugees’ applications for emergency or exceptional medical care. Neuropsychiatric diagnoses among refugee applicants were identified through a retrospective review of applications to the Jordanian Exceptional Care Committee (2012-2013). Diagnoses were made using International Classification of Disease-10th edition codes rendered by treating physicians.Other Research Uni

Options for National Parks and Reserves for Adapting to Climate Change

Past and present climate has shaped the valued ecosystems currently protected in parks and reserves, but future climate change will redefine these conditions. Continued conservation as climate changes will require thinking differently about resource management than we have in the past; we present some logical steps and tools for doing so. Three critical tenets underpin future management plans and activities: (1) climate patterns of the past will not be the climate patterns of the future; (2) climate defines the environment and influences future trajectories of the distributions of species and their habitats; (3) specific management actions may help increase the resilience of some natural resources, but fundamental changes in species and their environment may be inevitable. Science-based management will be necessary because past experience may not serve as a guide for novel future conditions. Identifying resources and processes at risk, defining thresholds and reference conditions, and establishing monitoring and assessment programs are among the types of scientific practices needed to support a broadened portfolio of management activities. In addition to the control and hedging management strategies commonly in use today, we recommend adaptive management wherever possible. Adaptive management increases our ability to address the multiple scales at which species and processes function, and increases the speed of knowledge transfer among scientists and managers. Scenario planning provides a broad forward-thinking framework from which the most appropriate management tools can be chosen. The scope of climate change effects will require a shared vision among regional partners. Preparing for and adapting to climate change is as much a cultural and intellectual challenge as an ecological challenge

The North American tree-ring fire-scar network

Fire regimes in North American forests are diverse and modern fire records are often too short to capture important patterns, trends, feedbacks, and drivers of variability. Tree-ring fire scars provide valuable perspectives on fire regimes, including centuries-long records of fire year, season, frequency, severity, and size. Here, we introduce the newly compiled North American tree-ring fire-scar network (NAFSN), which contains 2562 sites, >37,000 fire-scarred trees, and covers large parts of North America. We investigate the NAFSN in terms of geography, sample depth, vegetation, topography, climate, and human land use. Fire scars are found in most ecoregions, from boreal forests in northern Alaska and Canada to subtropical forests in southern Florida and Mexico. The network includes 91 tree species, but is dominated by gymnosperms in the genus Pinus. Fire scars are found from sea level to >4000-m elevation and across a range of topographic settings that vary by ecoregion. Multiple regions are densely sampled (e.g., >1000 fire-scarred trees), enabling new spatial analyses such as reconstructions of area burned. To demonstrate the potential of the network, we compared the climate space of the NAFSN to those of modern fires and forests; the NAFSN spans a climate space largely representative of the forested areas in North America, with notable gaps in warmer tropical climates. Modern fires are burning in similar climate spaces as historical fires, but disproportionately in warmer regions compared to the historical record, possibly related to under-sampling of warm subtropical forests or supporting observations of changing fire regimes. The historical influence of Indigenous and non-Indigenous human land use on fire regimes varies in space and time. A 20th century fire deficit associated with human activities is evident in many regions, yet fire regimes characterized by frequent surface fires are still active in some areas (e.g., Mexico and the southeastern United States). These analyses provide a foundation and framework for future studies using the hundreds of thousands of annually- to sub-annually-resolved tree-ring records of fire spanning centuries, which will further advance our understanding of the interactions among fire, climate, topography, vegetation, and humans across North America

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Cauchemars de R1: un cours de simulation pour les urgences durant la garde dirigé par des résidents et destiné aux résidents juniors

Implication Statement On-call medical emergencies can be a source of anxiety for junior medical residents. Senior resident teachers are well-positioned to teach a safe approach to managing on-call emergencies, and simulation-based training has educational and patient safety advantages. We describe the implementation of a resident-facilitated, on-call emergency simulation course for first-year residents. The course was low-cost, time-efficient, increased residents’ self-rated comfort with acutely deteriorating patients and was highly recommended by participants. The “R1 Nightmares” course could be adapted for other residency programs and institutions.Énoncé des implications de la recherche Les urgences durant la garde peuvent être une source d’anxiété pour les résidents juniors. Les résidents seniors se trouvent en situation privilégiée pour enseigner une approche sûre de la gestion des urgences sur la garde. De plus, la formation basée sur la simulation présente des avantages sur le plan pédagogique et sur le plan de la sécurité des patients. Nous décrivons la mise en œuvre d’un cours de simulation d’urgences survenant durant le service de garde destiné aux résidents de première année et animé par leurs collègues séniors. Nécessitant peu de temps et de ressources financières, le cours a permis aux résidents d’améliorer leur niveau de confort auprès des patients dont l’état se détériore rapidement et il a été fortement recommandé par les participants. Le cours « Cauchemars de R1 » peut être adapté à d’autres programmes de résidence et à d’autres établissements

“R1 Nightmares”: A resident-led on-call medical emergency simulation course for junior residents

Implication StatementOn-call medical emergencies can be a source of anxiety for junior medical residents. Senior resident teachers are well-positioned to teach a safe approach to managing on-call emergencies, and simulation-based training has educational and patient safety advantages. We describe the implementation of a resident-facilitated, on-call emergency simulation course for first-year residents. The course was low-cost, time-efficient, increased residents’ self-rated comfort with acutely deteriorating patients and was highly recommended by participants. The “R1 Nightmares” course could be adapted for other residency programs and institutions.Énoncé des implications de la rechercheLes urgences durant la garde peuvent être une source d’anxiété pour les résidents juniors. Les résidents seniors se trouvent en situation privilégiée pour enseigner une approche sûre de la gestion des urgences sur la garde. De plus, la formation basée sur la simulation présente des avantages sur le plan pédagogique et sur le plan de la sécurité des patients. Nous décrivons la mise en œuvre d’un cours de simulation d’urgences survenant durant le service de garde destiné aux résidents de première année et animé par leurs collègues séniors. Nécessitant peu de temps et de ressources financières, le cours a permis aux résidents d’améliorer leur niveau de confort auprès des patients dont l’état se détériore rapidement et il a été fortement recommandé par les participants. Le cours « Cauchemars de R1 » peut être adapté à d’autres programmes de résidence et à d’autres établissements

Prevalence of Exertional Rhabdomyolysis in Endurance Horses in the Pacific Northwestern United States

SUMMARY - REASONS FOR PERFORMING STUDY: Exertional rhabdomyolysis (ER) is a reported syndrome in competing endurance horses; however the prevalence and cause of ER in this population has not been defined. OBJECTIVES: To determine the prevalence of ER in a sample of endurance racing horses, and to investigate factors, including relevant genetic defects, contributing to the occurrence of rhabdomyolysis in this group. STUDY DESIGN: Prospective clinical study METHODS: Riders of 101 horses participating in one of four 50 mile distance races completed a comprehensive questionnaire regarding the medical history, management and performance of their horse. Serum creatine kinase activity (CK) was measured before and four hours after completion of exercise. Hair samples were analysed by PCR for the R309H mutation in the glycogen synthase gene (GYS1) responsible for Type 1 polysaccharide storage myopathy (PSSM) and the C7360G mutation in the ryanodine receptor 1 (RYR1) gene causing malignant hyperthermia (MH). RESULTS: Samples were obtained from 68 Arabians, 20 half-Arabians, and 13 horses of other breeds. Serum CK was above the resting reference interval (145-633 U/L) in 38 horses after racing (median 883 U/L, range 658–3,739) but was compatible with values previously reported in apparently healthy endurance horses. Pathologic ER was suspected to occur in four horses with serum CK activities exceeding 10,000 U/L four hours after racing (median 84,825 U/L; range 10,846 - 381,790) including three Arabians and one half-Arabian horse. GYS1 and RYR1 mutations were not present in hair samples from any horses. CONCLUSIONS: Exertional rhabdomyolysis occurred at a prevalence of 4.0% in a sample of horses participating in 50 mile distance events, and all affected horses were Arabian or half-Arabian. POTENTIAL RELEVANCE: The cause of ER in the endurance horse population remains unknown; however, ER in competing Arabian endurance horses is unlikely to be due to Type 1 PSSM or MH.Keywords: polysaccharide storage myopathy, horse, exercise, exertional rhabdomyolysi

Sarcolipin Exhibits Abundant RNA Transcription and Minimal Protein Expression in Horse Gluteal Muscle.

Ca2+ regulation in equine muscle is important for horse performance, yet little is known about this species-specific regulation. We reported recently that horse encode unique gene and protein sequences for the sarcoplasmic reticulum (SR) Ca2+-transporting ATPase (SERCA) and the regulatory subunit sarcolipin (SLN). Here we quantified gene transcription and protein expression of SERCA and its inhibitory peptides in horse gluteus, as compared to commonly-studied rabbit skeletal muscle. RNA sequencing and protein immunoblotting determined that horse gluteus expresses the ATP2A1 gene (SERCA1) as the predominant SR Ca2+-ATPase isoform and the SLN gene as the most-abundant SERCA inhibitory peptide, as also found in rabbit skeletal muscle. Equine muscle expresses an insignificant level of phospholamban (PLN), another key SERCA inhibitory peptide expressed commonly in a variety of mammalian striated muscles. Surprisingly in horse, the RNA transcript ratio of SLN-to-ATP2A1 is an order of magnitude higher than in rabbit, while the corresponding protein expression ratio is an order of magnitude lower than in rabbit. Thus, SLN is not efficiently translated or maintained as a stable protein in horse muscle, suggesting a non-coding role for supra-abundant SLN mRNA. We propose that the lack of SLN and PLN inhibition of SERCA activity in equine muscle is an evolutionary adaptation that potentiates Ca2+ cycling and muscle contractility in a prey species domestically selected for speed

Sarcolipin Exhibits Abundant RNA Transcription and Minimal Protein Expression in Horse Gluteal Muscle.

Ca2+ regulation in equine muscle is important for horse performance, yet little is known about this species-specific regulation. We reported recently that horse encode unique gene and protein sequences for the sarcoplasmic reticulum (SR) Ca2+-transporting ATPase (SERCA) and the regulatory subunit sarcolipin (SLN). Here we quantified gene transcription and protein expression of SERCA and its inhibitory peptides in horse gluteus, as compared to commonly-studied rabbit skeletal muscle. RNA sequencing and protein immunoblotting determined that horse gluteus expresses the ATP2A1 gene (SERCA1) as the predominant SR Ca2+-ATPase isoform and the SLN gene as the most-abundant SERCA inhibitory peptide, as also found in rabbit skeletal muscle. Equine muscle expresses an insignificant level of phospholamban (PLN), another key SERCA inhibitory peptide expressed commonly in a variety of mammalian striated muscles. Surprisingly in horse, the RNA transcript ratio of SLN-to-ATP2A1 is an order of magnitude higher than in rabbit, while the corresponding protein expression ratio is an order of magnitude lower than in rabbit. Thus, SLN is not efficiently translated or maintained as a stable protein in horse muscle, suggesting a non-coding role for supra-abundant SLN mRNA. We propose that the lack of SLN and PLN inhibition of SERCA activity in equine muscle is an evolutionary adaptation that potentiates Ca2+ cycling and muscle contractility in a prey species domestically selected for speed