Sickle Cell Patient and Parent Satisfaction with Pain Management in the Emergency Department

Sickle cell disease (SCD) is associated with significant morbidity, mortality and impaired quality of life. Vaso-occlusive pain crises are the hallmark of sickle cell disease and require frequent visits to the emergency room and admissions to the hospital. Even though national guidelines are available that address the ethical issues of pain management, patients with SCD often receive suboptimal pain control, especially during acute painful episodes. This project planned to determine some methods of improving patient care and satisfaction of pain management in hopes of being able to translate these methods to other health care systems.At the Children's Hospital of Pittsburgh (CHP) individualized pain plans, which include lists of each patient's most recent pain medications, have been in place since 2002. Retrospective data was analyzed to determine whether admission rates have decreased since this time due to improved care and treatment of patients with SCD. Additionally, patient and parent satisfaction with current pain management was evaluated by the use of surveys, with questions regarding overall perceptions of treatment and care. We had also proposed to implement a quality improvement program in the ED to further improve care of patients with sickle cell disease presenting with vaso-occlusive pain crises and then reassess patient and parent satisfaction. However, time restraints did not allow a quality improvement program to be implemented at this time.This study found that admission rates since 2002 had decreased at CHP, since the time that individualized pain plans were designed and put into practice. Baseline measurements of patient and parent satisfaction found that, overall, participants were satisfied with the care and treatment of pain they received in the ED. Future studies should involve developing further methods of improving patient satisfaction with pain management; a possible avenue to pursue may be working on decreasing wait times in the ED.The public health significance of this research is that increasing satisfaction by improved care, treatment, and pain management may lead to improved quality of life for patients with SCD; additionally, similar steps to be taken in other hospitals to increase the level of pain management that sickle cell patients receive

Calculations of liquid helium and neon VUV emission spectra, self-absorption and scattering for a neutrino detector

To evaluate the feasibility of the recently proposed detection scheme of low energy neutrinos released from the Sun and supernovae called CLEAN, Cryogenic Low Energy Astrophysics with Noble Gases, which relies on the transparency of noble-gas cryogenic liquids to VUV radiation produced by neutrinos, we analyze theoretically VUV emission, self-absorption, and scattering of liquid helium and neon, primary candidates for CLEAN. Owing to strong repulsion of noble-gas atoms in the ground states at the equilibrium distance of the relevant excited state, the emission spectrum is substantially shifted from the absorption spectrum, and in principle the absorption is expected very small, allowing building large detectors. Our analysis, however, shows that the self-absorption and Rayleigh scattering are comparable to the size of the proposed detector. Our theoretical emission spectra are found in agreement with experimental observations although some deviation exists due to binary-interaction approximation, and our ab initio Rayleigh scattering lengths are found in agreement with other calculations based on the extrapolation of experimental refraction indices. The absorption process can result in either re-emission, which conserves the number of photons but delays their escape from the liquid, or in non-radiative quenching

Thalidomide-induced Teratogenesis : History and Mechanisms

Peer reviewedPublisher PD

Seed production areas for the global restoration challenge

Wild-collected seed can no longer meet global demand in restoration. Dedicated Seed Production Areas (SPA) for restoration are needed and these require application of ecological, economic, and population-genetic science. SPA design and construction must embrace the ecological sustainability principles of restoration

Unraveling the directional link between adiposity and inflammation: a bidirectional mendelian randomization approach

<b>Context</b>: Associations between adiposity and circulating inflammation markers are assumed to be causal, although the direction of the relationship has not been proven. <b>Objective</b>: The aim of the study was to explore the causal direction of the relationship between adiposity and inflammation using a bidirectional Mendelian randomization approach. <b>Methods</b>: In the PROSPER study of 5804 elderly patients, we related C-reactive protein (CRP) single nucleotide polymorphisms (SNPs) (rs1800947 and rs1205) and adiposity SNPs (FTO and MC4R) to body mass index (BMI) as well as circulating levels of CRP and leptin. We gave each individual two allele scores ranging from zero to 4, counting each pair of alleles related to CRP levels or BMI. <b>Results</b>: With increasing CRP allele score, there was a stepwise decrease in CRP levels (P for trend < 0.0001) and a 1.98 mg/liter difference between extremes of the allele score distribution, but there was no associated change in BMI or leptin levels (P ≥ 0.89). By contrast, adiposity allele score was associated with 1) an increase in BMI (1.2 kg/m2 difference between extremes; P for trend 0.002); 2) an increase in circulating leptin (5.77 ng/ml difference between extremes; P for trend 0.0027); and 3) increased CRP levels (1.24 mg/liter difference between extremes; P for trend 0.002). <b>Conclusions</b>: Greater adiposity conferred by FTO and MC4R SNPs led to higher CRP levels, with no evidence for any reverse pathway. Future studies should extend our findings to other circulating inflammatory parameters. This study illustrates the potential power of Mendelian randomization to dissect directions of causality between intercorrelated metabolic factors

Development of Advanced Control Design Software for Researchers and Engineers

This paper provides a brief description of The μ Analysis and Synthesis Toolbox (μ-Tools), an advanced control design toolbox to be used in conjunction with MATLAB