The assessment of pain in older people

Pain is under-recognised and under-treated in older people. It is a subjective, personal experience, only known to the person who suffers. The assessment of pain is particularly challenging in the presence of severe cognitive impairment, communication difficulties or language and cultural barriers. These guidelines set out the key components of assessing pain in older people, together with a variety of practical scales that may be used with different groups, including those with varying levels of cognitive or communication impairment. The purpose is to provide professionals with a set of practical skills to assess pain as the first step towards its effective management. The guidance has implications for all healthcare and social care staff and can be applied in all settings, including the older person’s own home, in care homes, and in hospital

Properties of Hot Stars in the Wolf-Rayet galaxy NGC5253 from ISO Spectroscopy

ISO-SWS spectroscopy of the WR galaxy NGC5253 is presented, and analysed to provide estimates of its hot young star population. Our approach differs from previous investigations in that we are able to distinguish between the regions in which different infrared fine-structure lines form, using complementary ground-based observations. The high excitation nebular [SIV] emission is formed in a very compact region, which we attribute to the central super-star-nucleus, and lower excitation [NeII] nebular emission originates in the galactic core. We use photo-ionization modelling coupled with the latest theoretical O-star flux distributions to derive effective stellar temperatures and ionization parameters of Teff>38kK, logQ=8.25 for the compact nucleus, with Teff=35kK, logQ<8 for the larger core. Results are supported by more sophisticated calculations using evolutionary synthesis models. We assess the contribution that Wolf-Rayet stars may make to highly ionized nebular lines (e.g. [OIV]). From our Br(alpha) flux, the 2" nucleus contains the equivalent of approximately 1000 O7V star equivalents and the starburst there is 2-3Myr old; the 20" core contains about 2500 O7V star equivalents, with a representative age of 5Myr. The Lyman ionizing flux of the nucleus is equivalent to the 30 Doradus region. These quantities are in good agreement with the observed mid-IR dust luminosity of 7.8x10^8 L(sun) Since this structure of hot clusters embedded in cooler emission may be common in dwarf starbursts, observing a galaxy solely with a large aperture may result in confusion. Neglecting the spatial distribution of nebular emission in NGC5253, implies `global' stellar temperatures (or ages) of 36kK (4.8Myr) and 39kK (2.9 or 4.4Myr) from the observed [NeIII/II] and [SIV/III] line ratios, assuming logQ=8.Comment: 16 pages, 7 figures, uses mn.sty, to appear in MNRA

Indian River Lagoon surface water improvement and management (SWIM) plan, 2002 update.

In recognition of the need to place additional emphasis on the restoration, protection, and management of the surface water resources of the state, the Florida Legislature, through the Surface Water Improvement and Management (SWIM) Act of 1987, directed the state’s water management districts to “design and implement plans and programs for the improvement and management of surface water” (Section 373.451, Florida Statutes [FS]). The SWIM legislation requires the water management districts to protect the ecological, aesthetic, recreational, and economic value of the state’s surface water bodies, keeping in mind that water quality degradation is frequently caused by point and nonpoint source pollution and that degraded water quality can cause both direct and indirect losses of aquatic habitats. This 2002 update is the second update of the Indian River Lagoon SWIM Plan. This 2002 plan update includes a status report on the state of the Lagoon, a summary of progress on projects undertaken since the last update, and recommendations for future projects and other actions over the next 5 years. (262pp.

The effect of Holstein-Friesian genotype and feeding system on selected performance parameters of dairy cows on grass-based systems of milk production in Ireland

End of project reportThe overall objective of this project was to assess, the effect of strain of Holstein-Friesian dairy cow, pasture-based feed system (FS) and their interaction on animal performance in terms of milk productivity and lactation profile, body weight (BW), body condition score (BCS), feed intake and energy balance (EB), reproductive performance and overall economic profitability

Teaching Inquiry-Based STEM in the Elementary Grades Using Manipulatives: A SySTEMic Solution Report

Young learners come to school holding myriad conceptions about how the world works, particularly in the areas of science, technology, engineering, and mathematics, or STEM.1-3 Further, young students\u27 conceptions are commonly based on fragmented knowledge or naïve perspectives that contribute to the importance of early exposure to and practice with scrutinizing situations scientifically.1,3 An important part of helping children gain the skills necessary to approach situations scientifically involves preparing them to conduct scientific inquiry.3 The development of critical thinking skills and scientific approaches to problem solving should begin early in education.4 However, lack of elementary teacher comfort and familiarity with inquiry may be a significant barrier hindering early learner experience with and development of inquiry skills.5 Additionally, although engineering topics are particularly well suited for teaching inquiry, most teachers, like the general public, are not well versed in engineering. Therefore, teachers are excellent candidates for participation in professional development that enhances their knowledge and comfort with teaching inquiry-based STEM curriculum and engineering content in particular

Multivariate Generalizations of the Multiplicative Binomial Distribution: Introducing the MM Package

We present two natural generalizations of the multinomial and multivariate binomial distributions, which arise from the multiplicative binomial distribution of Altham (1978). The resulting two distributions are discussed and we introduce an R package, MM, whichincludes associated functionality

Cognitive debiasing 2: Impediments to and strategies for change

In a companion paper, we proposed that cognitive debiasing is a skill essential in developing sound clinical reasoning to mitigate the incidence of diagnostic failure. We reviewed the origins of cognitive biases and some proposed mechanisms for how debiasing processes might work. In this paper, we first outline a general schema of how cognitive change occurs and the constraints that may apply. We review a variety of individual factors, many of them biases themselves, which may be impediments to change. We then examine the major strategies that have been developed in the social sciences and in medicine to achieve cognitive and affective debiasing, including the important concept of forcing functions. The abundance and rich variety of approaches that exist in the literature and in individual clinical domains illustrate the difficulties inherent in achieving cognitive change, and also the need for such interventions. Ongoing cognitive debiasing is arguably the most important feature of the critical thinker and the well-calibrated mind. We outline three groups of suggested interventions going forward: educational strategies, workplace strategies and forcing functions. We stress the importance of ambient and contextual influences on the quality of individual decision making and the need to address factors known to impair calibration of the decision maker. We also emphasise the importance of introducing these concepts and corollary development of training in critical thinking in the undergraduate level in medical education

Magnetic White Dwarfs from the SDSS II. The Second and Third Data Releases

Fifty-two magnetic white dwarfs have been identified in spectroscopic observations from the Sloan Digital Sky Survey (SDSS) obtained between mid-2002 and the end of 2004, including Data Releases 2 and 3. Though not as numerous nor as diverse as the discoveries from the first Data Release, the collection exhibits polar field strengths ranging from 1.5MG to ~1000MG, and includes two new unusual atomic DQA examples, a molecular DQ, and five stars that show hydrogen in fields above 500MG. The highest-field example, SDSSJ2346+3853, may be the most strongly magnetic white dwarf yet discovered. Analysis of the photometric data indicates that the magnetic sample spans the same temperature range as for nonmagnetic white dwarfs from the SDSS, and support is found for previous claims that magnetic white dwarfs tend to have larger masses than their nonmagnetic counterparts. A glaring exception to this trend is the apparently low-gravity object SDSSJ0933+1022, which may have a history involving a close binary companion.Comment: 20 pages, 4 figures Accepted for publication in the Astronomical Journa

Amniotic fluid volume: Rapid MR-based assessment at 28-32 weeks gestation

Objectives: This work evaluates rapid magnetic resonance projection hydrography (PH) based amniotic fluid volume (AFV) estimates against established routine ultrasound single deepest vertical pocket (SDVP) and amniotic fluid index (AFI) measurements, in utero, at 28-32 weeks gestation. Manual multi-section planimetry (MSP) based measurement of AFV is used as a proxy reference standard. Methods: 35 women with a healthy singleton pregnancy (20-41 years) attending routine antenatal ultrasound were recruited. SDVP and AFI were measured using ultrasound, with same day MRI assessing AFV with PH and MSP. The relationships between the respective techniques were assessed using linear regression analysis and Bland-Altman method comparison statistics. Results: When comparing estimated AFV, a highly significant relationship was observed between PH and the reference standard MSP (R2=0.802, p<0.001). For the US measurements, SDVP measurement related most closely to amniotic fluid volume, (R2=0.470, p<0.001), with AFI demonstrating a weaker relationship (R2=0.208, p=0.007). Conclusion: This study shows that rapid MRI based PH measurement is a better predictor of AFV, relating more closely to our proxy standard than established US techniques. Although larger validation studies across a range of gestational ages are required this approach could form part of MR fetal assessment, particularly where poly or oligohydramnios is suspected.This study was supported by the National Institute of Health Research, Cambridge Biomedical Research Centre. The authors also acknowledge the support of Addenbrooke’s Charitable Trust and thank the participants for their contribution to the study.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s00330-015-4179-

A SySTEMic Solution: Elementary Teacher Preparation in STEM Expertise and Engineering Awareness

Research shows that most K-5 teachers are typically required to complete only minimal coursework in science and mathematics, which constrains their knowledge, efficacy, and confidence for teaching STEM (Science, Technology, Engineering and Math) content. Additionally, elementary teachers, like much of the general public, have limited comprehension about the relationship between STEM concepts and engineering fields and the kind of work and societal contributions made by engineers. Yet, elementary school is a critical time in which students develop foundational understanding of STEM concepts, career options, and inquiry learning. To address students\u27 STEM needs and limited teacher preparation, the Idaho SySTEMic Solution research project was implemented by the College of Education and College of Engineering at Boise State University, in partnership with the Meridian Joint School District and educational products and services company PCS Edventures! Funded by the U.S. Department of Education, the Idaho SySTEMic Solution is a STEM education initiative designed to advance achievement and confidence among elementary-age learners and their teachers. Phase I of the Idaho SySTEMic Solution, which is the subject of this report, focuses on teachers, with the goal of increasing their STEM content knowledge, instructional practices, awareness of engineering, and overall confidence for teaching STEM concepts. Phase I began with a three-day summer institute for 39 elementary teachers at seven schools representing socioeconomic diversity in the largest school district in Idaho. To measure the results of the workshop, several data collection methods were utilized, for pre- and post-intervention assessment. Repeated measures analyses revealed significant teacher increase in confidence to teach STEM curriculum (p \u3c .01), positive increase in engineering attitudes (p \u3c .01) and increase in STEM teaching efficacy (p \u3c .01) over the course of the threeday workshop. We attribute these changes to the content and context of the workshop instruction