The fear of needles: A systematic review and meta‐analysis

AimsThe aim of this study was to evaluate the prevalence of needle fear and summarize the characteristics of individuals who exhibit this fear.BackgroundInjections are among the most common medical procedures, yet fear of needles can result in avoidance of preventive measures and treatment.DesignSystematic review and meta‐analysis.Data SourcesMEDLINE (1966–2017), Embase (1947–2017), PsycINFO (1967–2017), and CINAHL (1961–2017) were searched, with no restrictions by age, gender, race, language, or country.Review MethodsThe prevalence of needle fear was calculated and restricted maximum likelihood random effects models were used for meta‐analysis and meta‐regression.ResultsThe search yielded 119 original research articles which are included in this review, of which 35 contained sufficient information for meta‐analysis. The majority of children exhibited needle fear, while prevalence estimates for needle fear ranged from 20‐50% in adolescents and 20–30% in young adults. In general, needle fear decreased with increasing age. Both needle fear and needle phobia were more prevalent in females than males. Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long‐term care facilities, and 8% of healthcare workers at hospitals. Needle fear was common when undergoing venipuncture, blood donation, and in those with chronic conditions requiring injection.ConclusionsFear of needles is common in patients requiring preventive care and in those undergoing treatment. Greater attention should be directed to interventions which alleviate fear in high‐risk groups.目的本研究旨在评估针头恐惧的发生率,并总结出现这种恐惧的个体的特征。背景注射是最常见的医疗程序之一,但对针头的恐惧会导致患者拒绝预防处理和治疗。设计系统回顾与元分析。数据来源搜索MEDLINE(1966‐2017)、Embase(1947‐2017)、PsycINFO(1967‐2017)和护理学数据库(CINAHL)(1961‐2017),不限制年龄、性别、种族、语言或国家。评价方法计算针头恐惧的发生率,采用限制性最大似然随机效应模型进行元分析和元回归分析。结果此次审查中检索出119篇原创研究论文,其中35篇包含足够的元分析信息。大多数儿童表现出针头恐惧症,而针头恐惧症的患病率估计在青少年中为20‐50%,年轻人为20‐30%。一般而言,随着年龄的增长,针头恐惧感也降低。女性的针头恐惧感和打针恐惧症比男性更普遍。16%的成年患者、27%的医院工作人员、18%的长期护理机构工作人员和8%的医院医务人员因害怕针头而避免接种流感疫苗。在静脉穿刺、献血和需要注射治疗的慢性疾病患者中,针头恐惧是一种常见现象。结论对针的恐惧在需要预防护理的患者和正在接受治疗的患者中很常见。应更加注重采取干预措施,减轻高危人群的针头恐惧。Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147205/1/jan13818_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147205/2/jan13818.pd

Towards a national platform for Australia’s islands

Islands are important for maintaining a range of biodiversity, cultural and economic values. However, islands around the world face major and complex conservation challenges, often shared across multiple islands. The variety of tenures and uses also means there is a lack of coordination in policy and management. Addressing these challenges requires sharing lessons of success and failure. To facilitate knowledge-sharing, we need to develop common frameworks, platforms, guidelines and legislation to devise, advise and support actions and collaborations aimed to enhance island conservation. These need to consider both human needs and biodiversity, interactions, research, practice, and information sharing across islands. Pathways may include knowledge, data and experience sharing to ensure that cross-State and Territory coordination can disseminate the lessons learned from island projects to island stakeholders and vice versa. We discuss examples of existing organisational management structures that can potentially form the basis for a timely new platform focusing on Australia’s islands. We propose an island alliance be established as a multi-disciplinary platform to improve coordination among Australia’s islands, and to represent Australia’s environmental island challenges and solutions. Such an alliance would aim to bridge island communities, practitioners, managers, researchers and cultural advisors across diverse and complementary spheres along the continuum from biodiversity and ecosystems to people and social entrepreneurship. This alliance would have a mandate to develop national environmental collaborations, research and standards relating to island environments, facilitate business entrepreneurship with complementary outcomes to manage the threats that face Australian islands, and contribute to improving biodiversity conservation outcomes. The platform would draw together practitioners, natural and social scientists, policymakers, and importantly indigenous and non-Indigenous island communities to lead innovative collaborations and support Australian islands

Challenging lanthanide relaxation theory: erbium and thulium complexes that show NMR relaxation rates faster than dysprosium and terbium analogues

Measurements of the proton NMR paramagnetic relaxation rates for several series of isostructural lanthanide(III) complexes have been performed in aqueous solution over the field range 1.0 to 16.5 Tesla. The field dependence has been modeled using Bloch–Redfield–Wangsness theory, allowing values for the electronic relaxation time, Tle and the magnetic susceptibility, μeff, to be estimated. Anomalous relaxation rate profiles were obtained, notably for erbium and thulium complexes of low symmetry 8-coordinate aza-phosphinate complexes. Such behaviour challenges accepted theory and can be interpreted in terms of changes in Tle values that are a function of the transient ligand field induced by solvent collision and vary considerably between Ln3+ ions, along with magnetic susceptibilities that deviate significantly from free-ion values

Telephone follow-up to identify incident lung cancer symptoms in COPD patients

Background: COPD patients are at very high risk of lung cancer, yet new respiratory symptoms of lung cancer may be particularly hard to identify. Aim: We sought to assess the feasibility of actively seeking lung cancer symptoms to improve the timeliness of diagnosis in this group. Design and setting: Observational study to evaluate the feasibility and practicability of the intervention. Patients were recruited from a primary care COPD register and were contacted by telephone 4-monthly over 12 months. Chest X-ray rates were assessed over the 20 months before, during the intervention and for 20 months following it, in both the study group and in patients on the register who did not volunteer for the intervention. Results: Most symptoms were identified at the first call, with 13 (17%) subjects admitting to a new persistent cough and 7 (9%) to a change in their cough. As a result of symptoms identified on the first call, 21 (27%) of the participating patients were referred for a chest X-ray and 4 (5%) were referred urgently to secondary care. Incident symptoms continued frequently to be identified at all subsequent calls, with an overall total of 49% of patients qualifying for and receiving a chest X-ray. Interestingly, the chest X-ray rate remained significantly elevated for the 20 months following the intervention, whilst there appeared to be little change in the non-study COPD patients. Conclusion: The intervention was readily practicable and lung cancer symptoms were frequently identified. The intervention may have resulted in a behavior change leading to a persistently higher chest X-ray rate, although the comparator group was not a formal control group and further assessment in a randomized control trial appears justified

Longitudinal study of short‐term corticosteroid use by working‐age adults with diabetes mellitus: Risks and mitigating factors

BackgroundThis study assessed the frequency of short‐term oral corticosteroid use in adults with diabetes, examined the incidence of fractures, venous thromboembolism (VTE), and hospitalization for sepsis after corticosteroid use, and evaluated whether preventative medications mitigated adverse events.MethodsA longitudinal study (2012–14) was conducted of 1 548 945 adults (aged 18–64 years) who received healthcare coverage through a large national health insurer. Incidence rate ratios (IRR) were calculated using conditional Poisson regression.ResultsShort‐term oral corticosteroids were used by 23.9%, 20.8%, and 20.9% of adults with type 2 diabetes, type 1 diabetes, and no diabetes, respectively, during the 3‐year period (P < 0.001). Baseline risks of fracture, VTE, and sepsis were greater for individuals with than without diabetes (P < 0.001). The combined effect of having diabetes and using corticosteroids was greater than the sum of the individual effects (synergy indices of 1.17, 1.23, 1.30 for fracture, VTE, and sepsis, respectively). The IRR for VTE in the 5–30 days after corticosteroid use was 3.62 (95% confidence interval [CI] 2.41–5.45). Fractures increased in the 5–30 days after corticosteroid use (IRR 2.06; 95% CI 1.52, 2.80), but concomitant use of ergocalciferol mitigated this risk (IRR 1.13; 95% CI 0.12, 11.07). The risk of hospitalization for sepsis was elevated with corticosteroid use (IRR 3.79; 95% CI 2.05, 7.01), but was mitigated by the concomitant use of statins.ConclusionsShort‐term oral corticosteroid use is common in adults with diabetes and is associated with an elevated, but low, risk of adverse events. The findings suggest that preventative medications may mitigate risk.摘要背景这项研究在成年糖尿病患者中评估了短期使用口服糖皮质激素的频率,  调查了使用糖皮质激素后骨折与静脉血栓栓塞(venous thromboembolism, VTE)的发生率以及脓毒症的住院率,  并且评估了预防性用药是否会减少不良事件。方法这是一项在1548945名具有大型国家健康保险公司医疗保险的成年(年龄为18‐64岁)患者中进行的纵向研究(2012‐14)。使用有条件的Poisson回归分析来计算发病率比(incidence rate ratios, IRR)。结果在这3年期间,  短期使用口服糖皮质激素治疗的2型糖尿病、1型糖尿病以及非糖尿病成年患者的比例分别为23.9%、20.8%与20.9%(P < 0.001)。与非糖尿病患者相比,  糖尿病患者基线时的骨折、VTE以及脓毒症的风险都更高(P < 0.001)。患糖尿病以及使用糖皮质激素的联合效应大于个体效应之和(骨折、VTE以及脓毒症的协同指数分别为1.17、1.23、1.30)。使用糖皮质激素后的5‐30日内发生VTE的IRR为3.62(95%置信区间[CI]为2.41‐5.45)。使用糖皮质激素后的5‐30日内发生骨折的风险增加(IRR为2.06;95% CI为1.52, 2.80),  但同时使用麦角骨化醇治疗可以减少这种风险(IRR为1.13;95% CI为0.12, 11.07)。使用糖皮质激素后脓毒症的住院风险也增加了(IRR为3.79;95% CI为2.05, 7.01),  但是同时使用他汀类药物治疗可以减少这种风险。结论成年糖尿病患者短期使用口服糖皮质激素治疗很常见并且与不良事件风险轻度升高有关。这项研究结果表明预防性用药可以减少这种风险。HighlightsAdults with diabetes mellitus have a greater risk of fracture, venous thromboembolism, and sepsis than those without diabetes; the use of corticosteroids, even for short durations, increases this risk.Vitamin D mitigated the risk of fracture in patients with diabetes who used corticosteroids, and statins decreased the likelihood of hospitalization for sepsis in corticosteroid users with diabetes.Corticosteroids should be used with caution in patients with diabetes and mitigating factors should be considered.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144644/1/jdb12631.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144644/2/jdb12631_am.pd

Evaluation of a microplate spectrophotometer for soil organic carbon determination in south-central Idaho

Soil organic carbon (SOC) is traditionally measured through dry combustion of soil but is inaccurate in soils recently limed or containing carbonates. Soils of south central Idaho contain carbonates therefore 3 alternative methods are typically used. Walkley-Black titration (WBTIT) has an extensive history but generates a large volume of hazardous waste for each sample analyzed. Low temperature loss on ignition (LOI360°C) may be utilized but requires frequent sample manipulation and is therefore prone to human error. A pressure calcimeter (Pcal) may be used, however the sample container may leak leading to inaccurate results. Therefore, a new method of SOC determination (WBSPEC) utilizing a microplate spectrophotometer was compared to LOI360°C, Pcal, and WBTIT in 75 south central Idaho soils and 10 standard soils. First, it was confirmed that soils of south central Idaho contain carbonates leading to inaccurate SOC determination by dry combustion. During the alternative method comparison, the WBSPEC method reduced waste production over the traditional WBTIT method by 89% while reducing sample handling over LOI360°C. The LOI360°C and WBTIT methods were most similar, however, the WBSPEC method performed adequately; the Pcal method often overestimated SOC compared to each other method. As the low SOC soils of south central Idaho were of particular interest, the methods were compared a second time on low SOC (<13.11 g kg-1) soils. Here, SOC determination was challenging however the WBSPEC method followed other methods well. It was determined that WBSPEC allows for accurate SOC determination in low SOC soils containing carbonates while reducing hazardous waste production and sample handling

Selberg Supertrace Formula for Super Riemann Surfaces III: Bordered Super Riemann Surfaces

This paper is the third in a sequel to develop a super-analogue of the classical Selberg trace formula, the Selberg supertrace formula. It deals with bordered super Riemann surfaces. The theory of bordered super Riemann surfaces is outlined, and the corresponding Selberg supertrace formula is developed. The analytic properties of the Selberg super zeta-functions on bordered super Riemann surfaces are discussed, and super-determinants of Dirac-Laplace operators on bordered super Riemann surfaces are calculated in terms of Selberg super zeta-functions.Comment: 43 pages, amste