Descriptive epidemiology of smothering in Australian commercial free-range layer hen farms

Since the early 2000 s the practice of free-range egg production has increased in developed countries, partly driven by consumer perception that free-range housing is better for hen welfare. While poultry in free-range systems have more behavioural opportunities compared with poultry in caged systems, free-range systems are associated with greater frequencies of infectious disease, predation and 'smothering', a condition where birds pile on top of one another with death occurring due to suffocation. Although the frequency of smothering deaths in Australian free-range layer poultry is anecdotally high, there is a lack of empirical evidence quantifying smothering cause-specific mortality rates and identifying factors that place birds at higher risk of death from smothering. This was a prospective cohort study of poultry flocks managed by three commercial free-range layer organisations in Eastern Australia. Flocks were enrolled into the study from 1 January 2019 to 29 March 2021 and were followed until the end of lay or until the end of the study on 31 March 2022, whichever occurred first. Throughout the follow-up period flock managers provided production details for each flock and details of smothering events using custom-designed logbooks.A total of 84 flocks were enrolled in the study: 32 from Organisation 1, 35 from Organisation 2 and 17 from Organisation 3. The number of birds per flock ranged from 16,000 to 45,000. The total mortality rate was 1131 deaths per 10,000 bird-years. Smothering mortality rate across the three organisations was 183 (minimum 133, maximum 223) deaths per 10,000 bird-years at risk. Smothering accounted for around 16% (minimum 9%, maximum 22%) of all deaths.We identified no distinctive temporal pattern in daily smothering risk as a function of either the number of days since placement or calendar date. The locations of smothering events in sheds and in the outdoor range were not consistent, with relatively large numbers of smothering events occurring in specific locations for some sheds but not others. To the best of our knowledge, this study is the largest prospective study of smothering mortality in commercial free-range layer flocks conducted to date. Estimates of smothering incidence rate and how that varies within and between flocks and organisations over time provides a critically important benchmark for further investigations into this substantial area of productivity loss.

Reduction of adverse events in a psychiatric inpatient eating disorder unit during the COVID-19 pandemic

TOPIC

Globally, the COVID-19 pandemic had impacted the health care delivery including inpatient psychiatric facilities. Within psychiatric settings, life of inpatients was profoundly altered.

PURPOSE

This paper aimed to understand if pandemic-related changes within an inpatient Eating Disorder Unit in a specialized psychiatric hospital in Ontario, Canada impacted incidence of aggression and use of coercive methods among adolescents.

SOURCE USED

An exploratory study design was used to examine incidence of aggression, self-harm, code whites, staff assist, restraints and seclusion, and nasogastric feeding (NGF) among adolescents with eating disorders before and after the modified service delivery within the inpatient unit. Descriptive analyses were conducted.

RESULTS

Analyses revealed a complete reduction in episodes of self-harm, aggression, staff assists, use of restraint and seclusion as well as an 80.14% reduction on average use of NGF.

CONCLUSION

Authors speculate that the change in environment and program delivery method, peer influence, and shift in power relations between patient and staff may have resulted in improved experiences. This report provides insights to adopt a recovery-oriented service delivery for adolescents with eating disorders in inpatient settings.

Gaussian-Distributed Spread-Spectrum for Covert Communications

Covert communication techniques play a crucial role in military and commercial applications to maintain the privacy and security of wireless transmissions from prying eyes. These techniques ensure that adversaries cannot detect or exploit the existence of such transmissions. Covert communications, also known as low probability of detection (LPD) communication, are instrumental in preventing attacks such as eavesdropping, jamming, or interference that could compromise the confidentiality, integrity, and availability of wireless communication. Direct-sequence spread-spectrum (DSSS) is a widely used covert communication scheme that expands the bandwidth to mitigate interference and hostile detection effects, reducing the signal power spectral density (PSD) to a low level. However, DSSS signals possess cyclostationary random properties that an adversary can exploit using cyclic spectral analysis to extract useful features from the transmitted signal. These features can then be used to detect and analyse the signal, making it more susceptible to electronic attacks such as jamming. To overcome this problem, a method to randomise the transmitted signal and reduce its cyclic features is proposed in this paper. This method produces a signal with a probability density function (PDF) similar to thermal noise, which masks the signal constellation to appear as thermal white noise to unintended receivers. This proposed scheme, called Gaussian distributed spread-spectrum (GDSS), is designed such that the receiver does not need to know any information about the thermal white noise used to mask the transmit signal to recover the message. The paper presents the details of the proposed scheme and investigates its performance in comparison to the standard DSSS system. This study used three detectors, namely, a high-order moments based detector, a modulation stripping detector, and a spectral correlation detector, to evaluate the detectability of the proposed scheme. The detectors were applied to noisy signals, and the results revealed that the moment-based detector failed to detect the GDSS signal with a spreading factor, N = 256 at all signal-to-noise ratios (SNRs), whereas it could detect the DSSS signals up to an SNR of -12 dB. The results obtained using the modulation stripping detector showed no significant phase distribution convergence for the GDSS signals, similar to the noise-only case, whereas the DSSS signals generated a phase distribution with a distinct shape, indicating the presence of a valid signal. Additionally, the spectral correlation detector applied to the GDSS signal at an SNR of -12 dB showed no identifiable peaks on the spectrum, providing further evidence of the effectiveness of the GDSS scheme and making it a favourable choice for covert communication applications. A semi-analytical calculation of the bit error rate is also presented for the uncoded system. The investigation results show that the GDSS scheme can generate a noise-like signal with reduced identifiable features, making it a superior solution for covert communication. However, achieving this comes at a cost of approximately 2 dB on the signal-to-noise ratio.

Silver linings: Observed reductions in aggression and use of restraints and seclusion in psychiatric inpatient care during COVID-19

WHAT IS KNOWN ABOUT THE SUBJECT?: In a survey conducted by the World Health Organization (WHO) in the summer of 2020, 93% of countries worldwide acknowledged negative impacts on their mental health services. Previous research during the H1N1 pandemic in 2009 established an increase of patient aggression in psychiatric facilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Despite expected worsening of mental health, our hospital observed reductions in aggressive behaviour among inpatients and subsequent use of coercive interventions by staff in the months following Covid-19 pandemic restrictions being implemented. The downward trend in incidents observed during the pandemic has suggested that aggression in mental health hospitals may be more situation-specific and less so a factor of mental illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We believe that the reduction in aggressive behaviour observed during the pandemic is related to changes in our organization that occurred in response to concerns about patient well-being; our co-design approach shifted trust, choice and power. Therefore, practices that support these constructs are needed to maintain the outcomes we experienced. Rather than return to normal in the wake of the pandemic, we are strongly encouraged to sustain the changes we made and continue to find better ways to support and work with the individuals who rely on or use our services. ABSTRACT: The global COVID-19 pandemic has dramatically changed the operation of health care such that many services were put on hold as patients were triaged differently, people delayed seeking care, and transition to virtual care was enacted, including in psychiatric facilities. Most of the media dialogue has been negative; however, there have been some silver linings observed. Coinciding with the pandemic has been a reduction in aggressive incidents at our psychiatric hospital, along with the decreased need to use restraints and seclusion to manage behaviour. In this paper, we are taking stock of the changes that have occurred in response to the pandemic in an attempt to share our learnings and offer suggestions so that health care does not necessarily return to "normal".

Perseverance rover reveals an ancient delta-lake system and flood deposits at Jezero crater, Mars

[Figure: see text].

Differences in obstetrical care and outcomes associated with the proportion of the obstetrician's shift completed

BACKGROUND

Understanding and improving obstetrical quality and safety is an important goal of professional societies, and many interventions such as checklists, safety bundles, educational interventions, or other culture changes have been implemented to improve the quality of care provided to obstetrical patients. Although many factors contribute to delivery decisions, a reduced workload has addressed how provider issues such as fatigue or behaviors surrounding impending shift changes may influence the delivery mode and outcomes.

OBJECTIVE

The objective was to assess whether intrapartum obstetrical interventions and adverse outcomes differ based on the temporal proximity of the delivery to the attending's shift change.

STUDY DESIGN

This was a secondary analysis from a multicenter obstetrical cohort in which all patients with cephalic, singleton gestations who attempted vaginal birth were eligible for inclusion. The primary exposure used to quantify the relationship between the proximity of the provider to their shift change and a delivery intervention was the ratio of time from the most recent attending shift change to vaginal delivery or decision for cesarean delivery to the total length of the shift. Ratios were used to represent the proportion of time completed in the shift by normalizing for varying shift lengths. A sensitivity analysis restricted to patients who were delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, third- or fourth-degree perineal laceration, 5-minute Apgar score of <4, and neonatal intensive care unit admission. Chi-squared tests were used to evaluate outcomes based on the proportion of the attending's shift completed. Adjusted and unadjusted logistic models fitting a cubic spline (when indicated) were used to determine whether the frequency of outcomes throughout the shift occurred in a statistically significant, nonlinear pattern RESULTS: Of the 82,851 patients eligible for inclusion, 47,262 (57%) had ratio data available and constituted the analyzable sample. Deliveries were evenly distributed throughout shifts, with 50.6% taking place in the first half of shifts. There were no statistically significant differences in the frequency of cesarean delivery, episiotomy, third- or fourth-degree perineal lacerations, or 5-minute Apgar scores of <4 based on the proportion of the shift completed. The findings were unchanged when evaluated with a cubic spline in unadjusted and adjusted logistic models. Sensitivity analyses performed on the 22.2% of patients who were delivered by a physician completing a 12-hour shift showed similar findings. There was a small increase in the frequency of neonatal intensive care unit admissions with a greater proportion of the shift completed (adjusted P=.009), but the findings did not persist in the sensitivity analysis.

CONCLUSION

Clinically significant differences in obstetrical interventions and outcomes do not seem to exist based on the temporal proximity to the attending physician's shift change. Future work should attempt to directly study unit culture and provider fatigue to further investigate opportunities to improve obstetrical quality of care, and additional studies are needed to corroborate these findings in community settings.

Extracting knowledge networks from plant scientific literature: potato tuber flesh color as an exemplary trait

BACKGROUND

Scientific literature carries a wealth of information crucial for research, but only a fraction of it is present as structured information in databases and therefore can be analyzed using traditional data analysis tools. Natural language processing (NLP) is often and successfully employed to support humans by distilling relevant information from large corpora of free text and structuring it in a way that lends itself to further computational analyses. For this pilot, we developed a pipeline that uses NLP on biological literature to produce knowledge networks. We focused on the flesh color of potato, a well-studied trait with known associations, and we investigated whether these knowledge networks can assist us in formulating new hypotheses on the underlying biological processes.

RESULTS

We trained an NLP model based on a manually annotated corpus of 34 full-text potato articles, to recognize relevant biological entities and relationships between them in text (genes, proteins, metabolites and traits). This model detected the number of biological entities with a precision of 97.65% and a recall of 88.91% on the training set. We conducted a time series analysis on 4023 PubMed abstract of plant genetics-based articles which focus on 4 major Solanaceous crops (tomato, potato, eggplant and capsicum), to determine that the networks contained both previously known and contemporaneously unknown leads to subsequently discovered biological phenomena relating to flesh color. A novel time-based analysis of these networks indicates a connection between our trait and a candidate gene (zeaxanthin epoxidase) already two years prior to explicit statements of that connection in the literature.

CONCLUSIONS

Our time-based analysis indicates that network-assisted hypothesis generation shows promise for knowledge discovery, data integration and hypothesis generation in scientific research.

Pre-slaughter factors linked to variation in responses to carbon dioxide gas stunning in pig abattoirs

The stunning process is an important component of slaughter with implications for animal welfare due to the potential distress and pain in the case of a sub-effective or lengthy stun. This study examined the factors correlated with variation in responses to carbon dioxide (CO₂) stunning of pigs in five Australian commercial abattoirs. A total of 1 769 pigs (199-492 focal pigs per abattoir) were individually followed from lairage to post-stunning. A standardised observation protocol was used based on a literature review of the pre-slaughter factors that may influence the reaction to CO₂ stunning, such as animal background, lairage conditions, handling, stunning system and conditions. Pigs lost posture 22.5 ± 0.2 s after commencement of descent of the gondola into the CO₂ chamber. Latency to loss of posture was associated with farm of origin and time of day, which could be linked to various factors. Pigs that crawled or attempted to escape while in the gondola within the CO₂ chamber took longer to lose posture. Crawl and escape attempts differed between abattoirs (0.6-46.2% of the pigs observed) as well as mounting other pigs (1.0-24.3%). Greater amounts of forceful contacts during handling in the race were related to more mounting in the gondola, but to less pigs crawling or attempting to escape. Mounting in the gondola was more frequent for pigs from lairage pens of mixed sexes, followed by pens of entire males and finally pens of females. Males were also twice as likely to show crawl and escape attempts than females. Gasping in the gondola was relatively frequent (63.1-81.8%) and was associated with higher activity in the lairage pen and higher skin injuries. Convulsions (60.1-69.6%) were generally observed after loss of posture. The type of CO₂ system (group-wise vs single-file loading) had no significant effect on behaviour in the gondola. Nevertheless, pigs slaughtered in abattoirs with group-wise loading systems and automatic gates had lower cortisol concentrations post-stunning, which may be linked to minimal handling by stockpeople, other factors related to the systems, or differences in timing of when blood samples were taken. In conclusion, substantial variation in the reaction of pigs to CO₂ stunning was observed between and within abattoirs using a uniform protocol for data collection. This variation in outcomes between abattoirs and stunning systems and the relationships between handling and behavioural outcomes indicates that improvements can be made to reduce aversive responses to CO₂ stunning. In particular, avoiding mixing pigs of different sexes in lairage and aversive handling in the race may reduce aversive response to CO₂ stunning.

Mild Cognitive Impairment and Decline in Resting State Functional Connectivity after Total Knee Arthroplasty with General Anesthesia

BACKGROUND

Research shows that older adults can have a decline in three key resting state networks (default mode network, central executive network, and salience network) after total knee arthroplasty and that patients' pre-surgery brain and cognitive integrity predicts decline.

OBJECTIVES

First, to assess resting state network connectivity decline from the perspective of nodal connectivity changes in a larger older adult surgery sample. Second, to compare pre-post functional connectivity changes in mild cognitive impairment (MCI) versus non-MCI.

METHODS

Surgery (n = 69) and non-surgery (n = 65) peers completed a comprehensive preoperative neuropsychological evaluation and pre- and acute (within 48 hours) post-surgery/pseudo-surgery functional brain magnetic resonance imaging scan. MCI was classified within both (MCI surgery, n = 13; MCI non-surgery, n = 10). Using standard coordinates, we defined default mode network, salience network, central executive network, and the visual network (serving as a control network). The functional connectivity of these networks and brain areas (nodes) that make up these networks were examined for pre-post-surgery changes through paired samples t-test and ANOVA.

RESULTS

There was a decline in RSN connectivity after surgery (p < 0.05) only in the three cognitive networks (not the visual network). The default mode and salience network showed nodal connectivity changes (p < 0.01). MCI surgery had greater functional connectivity decline in DMN and SN. Non-surgery participants showed no significant functional connectivity change.

CONCLUSION

Surgery with general anesthesia selectively alters functional connectivity in major cognitive resting state networks particularly in DMN and SN. Participants with MCI appear more vulnerable to these functional changes.

Role of rural general surgeons in managing vascular surgical emergencies

BACKGROUND

A rural general surgeon has historically been required to perform a wide variety of subspecialist procedures. Increasingly sub-specialized training programs have restricted younger surgeons' experience in the general surgery-associated subspecialties. Time critical vascular surgical emergencies are frequently encountered by rural general surgeons. This study aims to audit the prevalence of vascular surgical emergencies at a geographically remote regional centre and define the role of the general surgeon in managing these patients.

METHODS

A single-centre, retrospective study was performed to analyse the outcomes of the patients who presented to Dubbo Base Hospital with an emergency vascular pathology or developed such a condition during admission, between October 2010 and June 2019. Patients were identified by relevant International classification of diseases (ICD) (10th revision) diagnostic codes for vascular emergencies. Acute complications following surgery for haemodialysis access were excluded.

RESULTS

A total of 134 patients were identified during the study period and the majority were transferred to a tertiary centre for surgical intervention. Sixteen patients underwent emergency vascular surgery locally due to concerns about potential loss of life or limb if intervention was delayed by transfer; 69% of patients who underwent surgery locally survived with limb salvation.

CONCLUSION

While most patients can safely be transferred to a tertiary centre, some require surgery locally in order to maximize chance of life or limb preservation. There is a strong argument for exposure of general surgical trainees with an interest in rural surgery to vascular surgery and other subspecialties.

The End of the Road for the YSI 2300 Analyzer: Where Do We Go Now?

Production of the YSI 2300 STAT PLUS Glucose and l-Lactate Analyzer (YSI Incorporated, Yellow Springs, OH, United States) has been discontinued. This benchtop instrument is the most widely used device for determining the accuracy of products that measure blood glucose and interstitial fluid glucose. An alternate comparator instrument must now be identified by the diabetes diagnostics industry. The available products should be reviewed by parties interested in accurate, fast, low-cost comparator benchtop, or portable (nonstrip) methods using small sample volumes with good ease-of-use and human factors. Stakeholders include glucose monitor manufacturers, test labs, clinical chemists, diabetes clinicians, professional organizations, and regulators. This article presents features of eleven possible alternative instruments to be considered as comparator methods for measuring the accuracy of glucose monitors.

The YSI 2300 Analyzer Replacement Meeting Report

This is a summary report of the most important aspects discussed during the YSI 2300 Analyzer Replacement Meeting. The aim is to provide the interested reader with an overview of the complex topic and propose solutions for the current issue. This solution should not only be adequate for the United States or Europe markets but also for all other countries. The meeting addendum presents three outcomes of the meeting.

A case of a colonic foreign body imitating diverticulitis

We present a case of a 75-year-old male who was referred to an Emergency Department with possible diverticulitis. On further review of CT imaging, extensive sigmoid diverticulosis with mural thickening and inflammatory stranding was noted, with a linear dense foreign body present within the sigmoid lumen. The patient was managed with intravenous antibiotics and colonoscopic retrieval of the foreign body, which was lodged within a diverticulum. This case emphasizes the importance of early colonoscopic management of patients suspected to have a colonic foreign body. We then review the literature regarding colonic foreign bodies and the association with diverticulosis.

Patient Partnership: One Organization's Journey

Patient partnership has become a central element of healthcare delivery in many countries. The concept has specific relevance in mental health, as it is a critical enabler of recovery and healing (Bailey and Williams 2014). Patient partnership implies active engagement of patients in shaping decisions at the direct care, organizational and system level (Health Quality Ontario 2017). This article will outline the concept of patient partnership, and highlight the journey of one mental health.

Impact of Total Knee Arthroplasty with General Anesthesia on Brain Networks: Cognitive Efficiency and Ventricular Volume Predict Functional Connectivity Decline in Older Adults

Using resting state functional magnetic resonance imaging (RS-fMRI), we explored: 1) pre- to post-operative changes in functional connectivity in default mode, salience, and central executive networks after total knee arthroplasty (TKA) with general anesthesia, and 2) the contribution of cognitive/brain reserve metrics these resting state functional declines. Individuals age 60 and older electing unilateral total knee arthroplasty (TKA; n = 48) and non-surgery peers with osteoarthritis (n = 45) completed baseline cognitive testing and baseline and post-surgery (post-baseline, 48-h post-surgery) brain MRI. We acquired cognitive and brain estimates for premorbid (vocabulary, reading, education, intracranial volume) and current (working memory, processing speed, declarative memory, ventricular volume) reserve. Functional network analyses corrected for pain severity and pain medication. The surgery group declined in every functional network of interest (p < 0.001). Relative to non-surgery peers, 23% of surgery participants declined in at least one network and 15% of the total TKA sample declined across all networks. Larger preoperative ventricular volume and lower scores on preoperative metrics of processing speed and working memory predicted default mode network connectivity decline. Premorbid cognitive and premorbid brain reserve did not predict decline. Within 48 hours after surgery, at least one fourth of the older adult sample showed significant functional network decline. Metrics of current brain status (ventricular volume), working memory, and processing speed predicted the severity of default mode network connectivity decline. These findings demonstrate the relevance of preoperative cognition and brain integrity on acute postoperative functional network change.

Active dispersal in loggerhead sea turtles (Caretta caretta) during the 'lost years'

Highly migratory marine species can travel long distances and across entire ocean basins to reach foraging and breeding grounds, yet gaps persist in our knowledge of oceanic dispersal and habitat use. This is especially true for sea turtles, whose complex life history and lengthy pelagic stage present unique conservation challenges. Few studies have explored how these young at-sea turtles navigate their environment, but advancements in satellite technology and numerical models have shown that active and passive movements are used in relation to open ocean features. Here, we provide the first study, to the best of our knowledge, to simultaneously combine a high-resolution physical forcing ocean circulation model with long-term multi-year tracking data of young, trans-oceanic North Pacific loggerhead sea turtles during their 'lost years' at sea. From 2010 to 2014, we compare simulated trajectories of passive transport with empirical data of 1-3 year old turtles released off Japan (29.7-37.5 straight carapace length cm). After several years, the at-sea distribution of simulated current-driven trajectories significantly differed from that of the observed turtle tracks. These results underscore current theories on active dispersal by young oceanic-stage sea turtles and give further weight to hypotheses of juvenile foraging strategies for this species. Such information can also provide critical geographical information for spatially explicit conservation approaches to this endangered population.

The short-term behavioural response of sows, but not gilts, to a social stimulus is related to sow aggressiveness in groups

This study examined relationships between the behavioural response of pregnant gilts (n=200, gestation 1) and sows (n=200, gestation 2) to a live, similarly-aged female pig (unfamiliar pig test, UPT) and to a fibre-glass model pig (model pig test, MPT), and aggressive behaviour on the day after mixing (day 2). Sows with a short latency to make contact with an unfamiliar sow in the UPT were more likely to deliver high levels of aggression at day 2 of gestation 2 (P=0.005), but this relationship was stronger when a model pig was used (P<0.001). Similarly, sows with a long duration of tactile contact with the model pig in the MPT were more likely to deliver high levels of aggression at day 2 of gestation 2 (P=0.015), but this relationship was weaker than that between aggression and the latency to contact the model pig. When the terms the latency to contact the unfamiliar pig in the UPT and the model pig in the MPT, as well as the duration of contact with the model pig in the MPT, were included in an overall model of aggression at day 2 of gestation 2, behaviour towards the unfamiliar pig became not statistically significant (P>0.05). A strong relationship was not apparent with gilts (P>0.05). Thus, the socially inexperienced pig may not be an ideal model for sow behaviour. This study indicates that sows with a short latency to contact a model pig are more likely to be aggressive when mixed into groups.

Individual variation in sow aggressive behavior and its relationship with sow welfare

This study examined the relationships between individual sow aggressive behavior and sow welfare, based on aggression, skin injuries, and stress, in a total of 275 pregnant domestic sows. Over 4 time replicates, sows were randomly mixed into groups of 10 (floor space of 1.8 m/sow) within 7 d of insemination in both their first and second gestations (200 sows per gestation with 126 sows observed in both gestations). Measurements were taken on aggression (both delivered and received) at feeding, skin injuries, and plasma cortisol concentrations at d 2, 9, and 51 after mixing. Live weight gain, nonreproductive removals, litter size (born alive, total born, and stillborn piglets), and farrowing rate were also recorded. In both the first and the second gestations, sows were classified at d 2 after mixing as "submissive" (delivered little or no aggression at feeding relative to aggression received), "subdominant" (received more aggression at feeding than delivered), and "dominant" (delivered more aggression at feeding than received). In both gestations, sows classified as dominant at d 2 subsequently delivered more (gestation 1, < 0.01; gestation 2, < 0.01) and received less (gestation 1, < 0.01; gestation 2, < 0.01) aggression and gained the most weight (gestation 1, < 0.01; gestation 2, < 0.01). Dominant sows had the least skin injuries throughout gestation 1 ( = 0.04), and although submissive sows sustained the most skin injuries at d 9 and 51 of gestation 2, at d 2 the classifications did not differ in skin injuries ( < 0.01). Subdominant sows had the highest cortisol concentrations at d 2 of gestation 2, but there were no differences between classifications at d 9 and 51 in either gestation (gestation 1, > 0.05; gestation 2, = 0.02). There were no significant relationships between aggression classification and reproduction and nonreproductive removals ( > 0.05). In conclusion, sows classified as dominant at feeding at d 2 subsequently received less aggression at feeding, sustained fewer skin injuries, and had higher live weight gain. Submissive and subdominant sows in groups are likely to benefit from the provision of increased resources such as space and access to feed.

Orthopedic Surgery and Post-Operative Cognitive Decline in Idiopathic Parkinson's Disease: Considerations from a Pilot Study

BACKGROUND

Post-operative cognitive dysfunction (POCD) demarks cognitive decline after major surgery but has been studied to date in "healthy" adults. Although individuals with neurodegenerative disorders such as Parkinson's disease (PD) commonly undergo elective surgery, these individuals have yet to be prospectively followed despite hypotheses of increased POCD risk.

OBJECTIVE

To conduct a pilot study examining cognitive change pre-post elective orthopedic surgery for PD relative to surgery and non-surgery peers.

METHODS

A prospective one-year longitudinal design. No-dementia idiopathic PD individuals were actively recruited along with non-PD "healthy" controls (HC) undergoing knee replacement surgery. Non-surgical PD and HC controls were also recruited. Attention/processing speed, inhibitory function, memory recall, animal (semantic) fluency, and motor speed were assessed at baseline (pre-surgery), 3 weeks, 3 months, and 1 year post- orthopedic surgery. Reliable change methods examined individual changes for PD individuals relative to control surgery and control non-surgery peers.

RESULTS

Over two years we screened 152 older adult surgery or non-surgery candidates with 19 of these individuals having a diagnosis of PD. Final participants included 8 PD (5 surgery, 3 non-surgery), 47 Control Surgery, and 21 Control Non-Surgery. Eighty percent (4 of the 5) PD surgery declined greater than 1.645 standard deviations from their baseline performance on measures assessing processing speed and inhibitory function. This was not observed for the non-surgery PD individuals.

CONCLUSION

This prospective pilot study demonstrated rationale and feasibility for examining cognitive decline in at-risk neurodegenerative populations. We discuss recruitment and design challenges for examining post-operative cognitive decline in neurodegenerative samples.

Elevated Gluconeogenesis and Lack of Suppression by Insulin Contribute to Cystic Fibrosis-Related Diabetes

The incidence of diabetes is high in cystic fibrosis (CF) and is an important cause of morbidity and mortality. Understanding the pathophysiology is imperative. Studies have documented increased endogenous (mostly hepatic) glucose production (HGP) but have not distinguished the relative contribution of gluconeogenesis (GNG). The purpose of this study was to quantitate GNG, to determine its contribution to high HGP, and to measure insulin's suppression of GNG.

We recruited 31 adult CF subjects (age, 26.2 ± 7.9 years; 12 female subjects) and quantified GNG by measuring the incorporation of 2H into the second and fifth carbons of glucose. Hepatic glucose production was measured using [6,6-2H2]glucose. Protein breakdown was measured using [1-13C]leucine. Data were compared with that from 11 healthy volunteers (age, 27.5 ± 7.0 years) who underwent both GNG and clamp studies. Thirteen CF subjects and all controls had a hyperinsulinemic euglycemic clamp during measures of GNG. Other measures included glucose tolerance and glucagon and cortisol levels.

Rate of GNG was higher in CF subjects than controls and comprised a greater percentage of fasting HGP (GNG as percent of HGP: CF = 68%; controls = 44%; P = 0.034). Suppression of GNG by insulin was significantly lower in CF than in controls and was lower in CF subjects with abnormal glucose tolerance than in those with normal glucose tolerance. Gluconeogenesis correlated with protein breakdown.

These studies suggest that high HGP in CF is mostly from elevated rates of GNG and that resistance to insulin's suppression of GNG may contribute to abnormal glucose tolerance in CF.

Multi-year tracking reveals extensive pelagic phase of juvenile loggerhead sea turtles in the North Pacific

BACKGROUND

The juvenile stage of loggerhead sea turtles (Caretta caretta) can last for decades. In the North Pacific Ocean, much is known about their seasonal movements in relation to pelagic habitat, yet understanding their multi-year, basin-scale movements has proven more difficult. Here, we categorize the large-scale movements of 231 turtles satellite tracked from 1997 to 2013 and explore the influence of biological and environmental drivers on basin-scale movement.

RESULTS

Results show high residency of juvenile loggerheads within the Central North Pacific and a moderate influence of the Earth's magnetic field, but no real-time environmental driver to explain migratory behavior.

CONCLUSIONS

We suggest the Central North Pacific acts as important developmental foraging grounds for young juvenile loggerhead sea turtles, rather than just a migratory corridor. We propose several hypotheses that may influence the connectivity between western and eastern juvenile loggerhead foraging grounds in the North Pacific Ocean.

Achieving Remission in Gulf War Illness: A Simulation-Based Approach to Treatment Design

Gulf War Illness (GWI) is a chronic multi-symptom disorder affecting up to one-third of the 700,000 returning veterans of the 1991 Persian Gulf War and for which there is no known cure. GWI symptoms span several of the body’s principal regulatory systems and include debilitating fatigue, severe musculoskeletal pain, cognitive and neurological problems. Using computational models, our group reported previously that GWI might be perpetuated at least in part by natural homeostatic regulation of the neuroendocrine-immune network. In this work, we attempt to harness these regulatory dynamics to identify treatment courses that might produce lasting remission. Towards this we apply a combinatorial optimization scheme to the Monte Carlo simulation of a discrete ternary logic model that represents combined hypothalamic-pituitary-adrenal (HPA), gonadal (HPG), and immune system regulation in males. In this work we found that no single intervention target allowed a robust return to normal homeostatic control. All combined interventions leading to a predicted remission involved an initial inhibition of Th1 inflammatory cytokines (Th1Cyt) followed by a subsequent inhibition of glucocorticoid receptor function (GR). These first two intervention events alone ended in stable and lasting return to the normal regulatory control in 40% of the simulated cases. Applying a second cycle of this combined treatment improved this predicted remission rate to 2 out of 3 simulated subjects (63%). These results suggest that in a complex illness such as GWI, a multi-tiered intervention strategy that formally accounts for regulatory dynamics may be required to reset neuroendocrine-immune homeostasis and support extended remission.

Isosulfan Blue Dye Anaphylaxis Presenting as Impaired Ability to Ventilate via a Laryngeal Mask Airway

A 44-year-old woman presented for sentinel node biopsy and segmental mastectomy. After anesthetic induction, a laryngeal mask airway was placed, and ventilation was satisfactory. Three minutes after isosulfan blue dye injection, ventilation became difficult. The laryngeal mask airway was removed, and an endotracheal tube was easily placed. Twenty minutes later, she became hypotensive and unresponsive to phenylephrine, ephedrine, and vasopressin. With erythema and swelling in her arm and chest, low-dose epinephrine was titrated until her mean arterial blood pressure stabilized. Serum tryptase was increased to 27.2 μg/L (normal 0.4-10.9 μg/L).

Nonmedically indicated induction vs expectant treatment in term nulliparous women

OBJECTIVE

The purpose of this study was to compare maternal and neonatal outcomes in nulliparous women with nonmedically indicated inductions at term vs those expectantly treated.

STUDY DESIGN

Data were obtained from maternal and neonatal charts for all deliveries on randomly selected days across 25 US hospitals over a 3-year period. A low-risk subset of nulliparous women with vertex nonanomalous singleton gestations who delivered 38 0/7 to 41 6/7 weeks were selected. Maternal and neonatal outcomes for nonmedically indicated induction within each week were compared with women who did not undergo nonmedically indicated induction during that week. Multivariable analysis was used to adjust for hospital, maternal age, race/ethnicity, body mass index, cigarette use, and insurance status.

RESULTS

We found 31,169 women who met our criteria. Neonatal complications were either less frequent with nonmedically indicated induction or no different between groups. Nonmedically indicated induction was associated with less frequent peripartum infections (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.16-0.98) at 38 weeks of gestation and less frequent third- and fourth-degree lacerations (OR, 0.60; 95% CI, 0.42-0.86) and less frequent peripartum infections (OR, 0.66; 95% CI, 0.49-0.90) at 39 weeks of gestation. Nonmedically indicated induction was associated with a longer admission-to-delivery time by approximately 3-4 hours and increased odds of cesarean delivery at 38 (OR, 1.50; 95% CI, 1.08-2.08) and 40 weeks (OR, 1.30; 95% CI, 1.15-1.46) of gestation.

CONCLUSION

At 39 weeks of gestation, nonmedically indicated induction is associated with lower maternal and neonatal morbidity than women who are expectantly treated.

Mineralogy of a mudstone at Yellowknife Bay, Gale crater, Mars

Sedimentary rocks at Yellowknife Bay (Gale crater) on Mars include mudstone sampled by the Curiosity rover. The samples, John Klein and Cumberland, contain detrital basaltic minerals, calcium sulfates, iron oxide or hydroxides, iron sulfides, amorphous material, and trioctahedral smectites. The John Klein smectite has basal spacing of ~10 angstroms, indicating little interlayer hydration. The Cumberland smectite has basal spacing at both ~13.2 and ~10 angstroms. The larger spacing suggests a partially chloritized interlayer or interlayer magnesium or calcium facilitating H2O retention. Basaltic minerals in the mudstone are similar to those in nearby eolian deposits. However, the mudstone has far less Fe-forsterite, possibly lost with formation of smectite plus magnetite. Late Noachian/Early Hesperian or younger age indicates that clay mineral formation on Mars extended beyond Noachian time.

The learning style preferences of chiropractic students: A cross-sectional study

Objective : The aims of our study were to measure the learning style preferences of chiropractic students and to assess whether they differ across the 5 years of chiropractic study. Methods : A total of 407 (41.4% females) full-degree, undergraduate, and postgraduate students enrolled in an Australian chiropractic program agreed to participate in a cross-sectional survey comprised of basic demographic information and the Visual, Aural, Read/Write, Kinesthetic (VARK) questionnaire, which identifies learning preferences on four different subscales: visual, aural, reading/writing, and kinesthetic. Multivariate analysis of variance and the χ(2) test were used to check for differences in continuous (VARK scores) and categorical (VARK category preference) outcome variables. Results : The majority of chiropractic students (56.0%) were found to be multimodal learners. Compared to the other learning styles preferences, kinesthetic learning was preferred by a significantly greater proportion of students (65.4%, p < .001) and received a significantly greater mean VARK score (5.66 ± 2.47, p < .001). Conclusions : To the best of our knowledge, this is the first time chiropractic students have been shown to be largely multimodal learners with a preference for kinesthetic learning. While this knowledge may be beneficial in the structuring of future curricula, more thorough research must be conducted to show any beneficial relationship between learning style preferences and teaching methods.