We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Florpyrauxifen-benzyl is a postemergence (POST) rice herbicide that has reduced rice yield in some situations, and producers are concerned that the impact could be even greater with low rice seeding densities. Therefore, research was conducted in Stoneville, MS, from 2019 to 2021 to evaluate the effect of florpyrauxifen-benzyl on rice yield when a hybrid was seeded at reduced densities. Hybrid rice ‘RT 7521 FP’ was seeded at 10, 17, 24, 30, and 37 kg ha-1. At the four-leaf to one-tiller growth stage, florpyrauxifen-benzyl was applied at 0 or 59 g ai ha-1. Rice injury following the application of florpyrauxifen-benzyl was ≤ 8% across all seeding rates and evaluation intervals. Application of florpyrauxifen-benzyl reduced plant heights by 14% across all seeding rates but did not result in delayed rice maturity. When florpyrauxifen-benzyl was not applied rice in the 10 and 17 kg ha-1 seeding rates, rice matured slower than when seeded at 24, 30, and 37 kg ha-1. When florpyrauxifen-benzyl was applied, rough rice grain yields were reduced by 17 and 37 kg ha-1 but not at any other seeding rate. In conclusion, the application of florpyrauxifen-benzyl at a 2x rate can cause a loss of yield resulting from variation in rice densities.
The difficulties in accessing Child and Adolescent Mental Health Services (CAMHS) and the lack of out-of-hours and crises services have resulted in Ireland’s national police force, An Garda Síochána (GS), becoming increasingly involved as first responders to children and young people (CYP) who are experiencing potential mental health crises.
Aims:
To outline challenges faced by members of GS and emergency department (ED) professionals in such cases.
Method:
Qualitative study design with semi-structured interviews conducted with a convenience sample of medical and mental health professionals (n = 11) from a paediatric ED who are frequently involved with the interface between GS and CYP experiencing potential mental health crises. Thematic analysis was conducted on transcribed interviews using the software package MaxQDA to systematically organise and code transcriptions.
Results:
Participants highlighted a lack of appropriate clinical settings within the ED for CYP who attend with a mental health crisis through GS. Whilst participants described positive rapport between GS and ED staff, interactions between GS and patients were identified as challenging. Knowledge gaps amongst members of GS in Mental Health Act (MHA) legislation and restraint were also identified as contributory stressors for GS and emergency department professionals.
Conclusion:
The increased prevalence of CYP mental health issues and psychosocial stressors in conjunction with difficulty in accessing CAMHS means that challenges faced by GS as first responders are likely to continue. Research is needed to quantify the adverse personal impacts on GS along with the potential negative impact on youth. Access to emergency mental health review for youth is essential to optimise the experience of both groups.
Barnyardgrass and other troublesome weeds have become a major problem for producers in a flooded rice system. Cultural control options and more efficient herbicide applications have become a priority to increase efficiency and weed control in rice. This study aimed to determine the effects of row width and nozzle selection on spray coverage and weed control in a flooded rice system. A field experiment was conducted at 7 site-years (Lonoke, AR, in 2021 and 2022; Pine Tree, AR, in 2021 and 2022; Rohwer, AR, in 2022; and Stoneville, MS, in 2021 and 2022) as a randomized complete block split-plot design. Five nozzles (XR, AIXR, TTI, TTI60, and AITTJ60) (subplot factor) were used for herbicide applications, and plots were drill-seeded in four row widths (whole plot factor) (13, 19, 25, and 38 cm). A droplet size experiment was conducted to evaluate the droplet size and velocity of each nozzle type used in the field experiment. Overall, as row width increased, barnyardgrass density increased. The rice grown in a wider width took longer to generate canopy closure, allowing weed escapes in the crop. For example, the 13-cm width had a 12 percentage point canopy coverage increase compared to the 38-cm row width at the preflood timing resulting in a reduction of six barnyardgrass plants per square meter. The smallest droplet size-producing nozzle (XR) provided greater weed control throughout the study but is more prone to drift. The dual-fan nozzles (AITTJ60 and TTI60) had variable weed control impacts, and it was difficult to predict when this might occur; however, they did have increased deposits on water-sensitive cards compared to single-fan counterparts (AIXR and TTI). In conclusion, a narrower row width (e.g., 19-cm or less) and a smaller droplet size producing nozzle (XR) are optimal for barnyardgrass control in a flooded rice system.
Florpyrauxifen-benzyl was commercialized in 2018 to target barnyardgrass and aquatic or broadleaf weeds. Field studies were conducted from 2019 to 2021 in Stoneville, MS, to evaluate barnyardgrass control following a simulated failure of florpyrauxifen-benzyl or other common postemergence rice herbicides. In the first field study, florpyrauxifen-benzyl was applied at 0 and 15 g ai ha–1 to rice at the two- to three-leaf stage to simulate a failed application targeting barnyardgrass. Sequential herbicide treatments included no herbicide and full rates of imazethapyr, quinclorac, bispyribac-Na, and cyhalofop applied 7 or 14 d after florpyrauxifen-benzyl treatment. The second field study was designed to evaluate barnyardgrass control with florpyrauxifen-benzyl following simulated failure of postemergence rice herbicides. Initial herbicide treatments included no herbicide and half rates of imazethapyr, quinclorac, bispyribac-Na, and propanil. Sequential applications at 7 or 14 d after the initial herbicide treatments included florpyrauxifen-benzyl at 0 and 30 g ai ha–1. Results from the first study indicated barnyardgrass control 21 d after final treatment (DAFT) was greater with sequential treatments at 7 compared with 14 d after initial treatment (DA-I) with no initial application of florpyrauxifen-benzyl. Therefore, delaying sequential treatments until 14 d after initial florpyrauxifen-benzyl at 15 g ha–1 allowed barnyardgrass to become too large to control with other rice herbicides. Rough rice yield was reduced in plots where quinclorac application was delayed from 7 to 14 DA-I with no initial application of florpyrauxifen-benzyl. The second study suggested that florpyrauxifen-benzyl application should be delayed 14 d after a herbicide failure. Although no differences in barnyardgrass control 21 DAFT were detected whether florpyrauxifen-benzyl was applied 7 or 14 DA-I of any herbicide utilized, >85% control was only achieved when florpyrauxifen-benzyl application was delayed 14 DA-I. These results demonstrate barnyardgrass control options following simulated failed applications of common rice herbicides.
Sleep problems are common amongst children and adolescents with attention deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate sleep problems in children and adolescents attending a specialist ADHD service.
Methods:
This was a cross-sectional online survey combined with a retrospective chart review, conducted in the ADHD Assessment, Diagnosis, Management, initiation, Research and Education (ADMiRE) service, the first public specialist ADHD service for young people in Ireland. Participants were caregivers of children and adolescents with ADHD attending ADMiRE. Sleep was assessed using The Children’s Sleep Habits Questionnaire (CSHQ) and ADHD symptoms were assessed using an abbreviated version of the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV). Details regarding patient demographics, co-morbidities and medication were collected from patient records.
Results:
Eighty-four percent of young people scored above the clinical cut-off for a sleep disorder. The most frequently reported sleep problems were related to sleep onset and sleep duration, and 64% of respondents met the criteria for two or more sleep problems. ADHD severity was associated with greater sleep problems. Co-morbid physical, neurodevelopmental, and mental health disorders as well as stimulant use were not associated with greater sleep problems.
Conclusion:
Sleep problems are very common amongst children and adolescents with ADHD. This study has demonstrated an association between more sleep problems and ADHD severity. These findings highlight the need for both effective ADHD treatment to ensure optional sleep in young people as well as effective interventions for sleep problems to prevent worsening of ADHD symptoms.
The Red Sea is a largely homogeneous water column beyond the top 300 m, unique in exhibiting warm bottom water (~21.5 °C) at depths down to ~2900 m. The unusual conditions coupled with barriers to colonization by primary deep-sea species has resulted in an impoverished but distinct deep fauna. This study presents a rare investigation of the deep Red Sea. The bigeye hound shark Iago omanensis is a known deep-sea shark in the Red Sea. However, its full depth distribution has never been conclusively studied. Here, we confirm with videographic evidence the presence of I. omanensis at depths to 2522 m in the Red Sea, along with observations of other deep-sea species. Iago omanensis was the only species of scavenging fish observed and only in moderate numbers. The additional six species were mostly crustacea in low abundance. The lack of scavenging species present in the deep Red Sea is likely explained by the low productivity of the overlying surface waters and unusually warm water temperature resulting in low energetic input but high metabolic demands in deep communities.
From 2016–2019, dry bulb onions were the suspected cause of three multistate outbreaks in the United States. We investigated a large multistate outbreak of Salmonella Newport infections that caused illnesses in both the United States and Canada in 2020. Epidemiologic, laboratory and traceback investigations were conducted to determine the source of the infections, and data were shared among U.S. and Canadian public health officials. We identified 1127 U.S. illnesses from 48 states with illness onset dates ranging from 19 June to 11 September 2020. Sixty-six per cent of ill people reported consuming red onions in the week before illness onset. Thirty-five illness sub-clusters were identified during the investigation and seventy-four per cent of sub-clusters served red onions to customers during the exposure period. Traceback for the source of onions in illness sub-clusters identified a common onion grower in Bakersfield, CA as the source of red onions, and onions were recalled at this time. Although other strains of Salmonella Newport were identified in environmental samples collected at the Bakersfield, CA grower, extensive environmental and product testing did not yield the outbreak strain. This was the third largest U.S. foodborne Salmonella outbreak in the last 30 years. It is the first U.S. multistate outbreak with a confirmed link to dry bulb onions, and it was nearly 10-fold larger than prior outbreaks with a suspected link to onions. This outbreak is notable for its size and scope, as well as the international data sharing that led to implication of red onions as the primary cause of the outbreak. Although an environmental assessment at the grower identified several factors that likely contributed to the outbreak, no main reason was identified. The expedient identification of the outbreak vehicle and response of multiple public health agencies allowed for recall and removal of product from the marketplace, and rapid messaging to both the public and industry on actions to protect consumers; these features contributed to a decrease in cases and expeditious conclusion of the outbreak.
The Richtmyer–Meshkov instability (RMI) results from the impulsive acceleration of a density interface where either it or the acceleration is perturbed. Density interfaces may arise due to a change in gas species, isotope, temperature or a combination of these. We computationally investigate the effect of interface type on the plasma RMI, which is relevant for a range of applications, including inertial confinement fusion. We simulate the evolution of single-mode perturbed thermal, species and isotope interfaces in an ideal ion–electron plasma using the multi-fluid plasma (MFP) model. We find that, in the MFP model, the evolution of different types of interface differs significantly, in contrast to single-fluid models where they behave similarly if the Atwood number is matched. The thermal and species interfaces produce the most severe response to shock acceleration, experiencing the secondary instabilities and enhanced primary mode growth. The isotope interface evolution is restrained in comparison with the former cases, resembling the response predicted by single-fluid models. The determining factor in the severity of the MFP RMI is the density ratio across the initial interface in the electron fluid, which is unity for an isotope interface. We observe that, as the density ratio across the electron interface decreases, so do the magnitudes of the self-generated fields and consequently the severity of the growth amplification. Generally, the evolution of the RMI with different types of interface becomes more similar as the level of coupling between the ion and electron fluids is increased, characterised by reducing the plasma non-dimensional skin depth.
Seed retention, and ultimately seed shatter, are extremely important for the efficacy of harvest weed seed control (HWSC) and are likely influenced by various agroecological and environmental factors. Field studies investigated seed-shattering phenology of 22 weed species across three soybean [Glycine max (L.) Merr.]-producing regions in the United States. We further evaluated the potential drivers of seed shatter in terms of weather conditions, growing degree days, and plant biomass. Based on the results, weather conditions had no consistent impact on weed seed shatter. However, there was a positive correlation between individual weed plant biomass and delayed weed seed–shattering rates during harvest. This work demonstrates that HWSC can potentially reduce weed seedbank inputs of plants that have escaped early-season management practices and retained seed through harvest. However, smaller individuals of plants within the same population that shatter seed before harvest pose a risk of escaping early-season management and HWSC.
Can data on government coercion and violence be trusted when the data are generated by state itself? In this paper, we investigate the extent to which data from the California Department of Corrections and Rehabilitation (CDCR) regarding the use of force by corrections officers against prison inmates between 2008 and 2017 conform to Benford's Law. Following a growing data forensics literature, we expect misreporting of the use-of-force in California state prisons to cause the observed data to deviate from Benford's distribution. Statistical hypothesis tests and further investigation of CDCR data—which show both temporal and cross-sectional variance in conformity with Benford's Law—are consistent with misreporting of the use-of-force by the CDCR. Our results suggest that data on government coercion generated by the state should be inspected carefully before being used to test hypotheses or make policy.
Potential effectiveness of harvest weed seed control (HWSC) systems depends upon seed shatter of the target weed species at crop maturity, enabling its collection and processing at crop harvest. However, seed retention likely is influenced by agroecological and environmental factors. In 2016 and 2017, we assessed seed-shatter phenology in 13 economically important broadleaf weed species in soybean [Glycine max (L.) Merr.] from crop physiological maturity to 4 wk after physiological maturity at multiple sites spread across 14 states in the southern, northern, and mid-Atlantic United States. Greater proportions of seeds were retained by weeds in southern latitudes and shatter rate increased at northern latitudes. Amaranthus spp. seed shatter was low (0% to 2%), whereas shatter varied widely in common ragweed (Ambrosia artemisiifolia L.) (2% to 90%) over the weeks following soybean physiological maturity. Overall, the broadleaf species studied shattered less than 10% of their seeds by soybean harvest. Our results suggest that some of the broadleaf species with greater seed retention rates in the weeks following soybean physiological maturity may be good candidates for HWSC.
Seed shatter is an important weediness trait on which the efficacy of harvest weed seed control (HWSC) depends. The level of seed shatter in a species is likely influenced by agroecological and environmental factors. In 2016 and 2017, we assessed seed shatter of eight economically important grass weed species in soybean [Glycine max (L.) Merr.] from crop physiological maturity to 4 wk after maturity at multiple sites spread across 11 states in the southern, northern, and mid-Atlantic United States. From soybean maturity to 4 wk after maturity, cumulative percent seed shatter was lowest in the southern U.S. regions and increased moving north through the states. At soybean maturity, the percent of seed shatter ranged from 1% to 70%. That range had shifted to 5% to 100% (mean: 42%) by 25 d after soybean maturity. There were considerable differences in seed-shatter onset and rate of progression between sites and years in some species that could impact their susceptibility to HWSC. Our results suggest that many summer annual grass species are likely not ideal candidates for HWSC, although HWSC could substantially reduce their seed output during certain years.
We investigate the effects of magnetisation on the two-fluid plasma Richtmyer–Meshkov instability of a single-mode thermal interface using a computational approach. The initial magnetic field is normal to the mean interface location. Results are presented for a magnetic interaction parameter of 0.1 and plasma skin depths ranging from 0.1 to 10 perturbation wavelengths. These are compared to initially unmagnetised and neutral fluid cases. The electron flow is found to be constrained to lie along the magnetic field lines resulting in significant longitudinal flow features that interact strongly with the ion fluid. The presence of an initial magnetic field is shown to suppress the growth of the initial interface perturbation with effectiveness determined by plasma length scale. Suppression of the instability is attributed to the magnetic field's contribution to the Lorentz force. This acts to rotate the vorticity vector in each fluid about the local magnetic-field vector leading to cyclic inversion and transport of the out-of-plane vorticity that drives perturbation growth. The transport of vorticity along field lines increases with decreasing plasma length scales and the wave packets responsible for vorticity transport begin to coalesce. In general, the two-fluid plasma Richtmyer–Meshkov instability is found to be suppressed through the action of the imposed magnetic field with increasing effectiveness as plasma length scale is decreased. For the conditions investigated, a critical skin depth for instability suppression is estimated.
Background: Ketorolac has long been used to manage pain in the Emergency Department and has the advantage of being the only parenteral NSAID formulation. Despite multiple studies demonstrating an analgesic ceiling dose of 10mg for intravenous ketorolac, higher doses (30-60mg) are commonly ordered. Use of optimal doses of ketorolac (10mg) has the advantage of lower side effects and cost. Aim Statement: The aim of this project was to increase the usage of the optimal dose parenteral ketorolac (10mg) without increasing the use of additional, concomitant or rescue opioids (balancing measures). Measures & Design: This pre-/post-intervention comparison study (May 1, 2016 to April 30, 2018) included all patients ≥18 years of age that received parenteral ketorolac at one of 4 EDs in the Calgary zone. All data was captured via administrative data records. Stakeholders (ED leadership, analgesia committee, nursing and pharmacy) provided feedback and support for the project. Our multi-modal intervention included modifying all ED computerized order sets such that the default parenteral ketorolac dose was 10mg (post-intervention) from 30mg (pre-intervention), education (dissemination of evidence to support the changes to clinicians) and our pharmacy securing 10mg vials of ketorolac. At their discretion, physicians’ were still able to order other doses of ketorolac. Evaluation/Results: During the 2 year study period, 19290 patient records were identified where parenteral ketorolac was administered during the ED visit. Baseline characteristics were similar between the pre/post periods. Prior to the change in default dosing, 10.5% of orders were for ketorolac 10mg compared to 87% in the post-intervention period (p < 0.000). Statistical process charts support the above results and demonstrate that the changes have been sustained. There were no differences in patients receiving ketorolac as the only analgesic between the pre/post periods (42% vs 42%, p = 0.396), nor where there significant changes in concomitant opioid usage (46% vs 46%, p = 0.817), or rescue analgesia (11% vs 12%, p = 0.097). Discussion/Impact: In this large cohort, our multi-modal intervention, resulted in a significant increase in optimal ketorolac parenteral dosing without a significant change in additional opioid use. The results support the utility of computerized order set changes as the cornerstone of an effective and rapid knowledge translation strategy to align physician practice with best evidence.
Recently, several incidents of glyphosate failure on junglerice [Echinochloa colona (L.) Link] have been reported in the midsouthern United States, specifically in Mississippi and Tennessee. Research was conducted to measure the magnitude of glyphosate resistance and to determine the mechanism(s) of resistance to glyphosate in E. colona populations from Mississippi and Tennessee. ED50 (dose required to reduce plant growth by 50%) values for a resistant MSGR4 biotype, a resistant TNGR population, and a known susceptible MSGS population were 0.8, 1.62, and 0.23 kg ae ha−1 of glyphosate, respectively. The resistance index calculated from the these ED50 values indicated that the MSGR4 biotype and TNGR population were 4- and 7-fold, respectively, resistant to glyphosate relative to the MSGS population. The absorption patterns of [14C]glyphosate in the TNGR and MSGS populations were similar. However, the MSGS population translocated 13% more [14C]glyphosate out of the treated leaf compared with the TNGR population at 48 h after treatment. EPSPS gene sequence analyses of TNGR E. colona indicated no evidence of any point mutations, but several resistant biotypes, including MSGR4, possessed a single-nucleotide substitution of T for C at codon 106 position, resulting in a proline-to-serine substitution (CCA to TCA). Results from quantitative polymerase chain reaction analyses suggested that there was no amplification of the EPSPS gene in the resistant populations and biotypes. Thus, the mechanism of resistance in the MSGR population (and associated biotypes) is, in part, due to a target-site mutation at the 106 loci of the EPSPS gene, while reduced translocation of glyphosate was found to confer glyphosate resistance in the TNGR population.
The 2008 UK government White Paper, published as part of the Managing Radioactive Waste Safety programme, identified benefits to disposing of all of the UK's higher activity wastes at the same site. That is, a single geological disposal facility (GDF) could be constructed that consists of a module for low- and intermediate-level waste, and a module for high-level waste and spent fuel.
A safety case for a co-located GDF will have to consider the extent to which evolving thermo-hydro-mechanical-chemical and gas (THMCG) conditions in and around one module may affect conditions in the other module, including the extent to which barrier performance and radionuclide migration behaviour could be altered. Several research projects have been undertaken on behalf of Radioactive Waste Management Directorate aimed at understanding and evaluating the THMCG interactions that might occur during the disposal facility operational and post-closure phases.
This paper describes research on THMCG interactions between disposal modules based on illustrative GDF designs for different host rock environments. Interactions were evaluated using simple analytical solutions and detailed three-dimensional models. The analyses demonstrated that interactions can be controlled by design constraints.
Herbicide resistance, and in particular multiple-herbicide resistance, poses an ever-increasing threat to food security. A biotype of junglerice [Echinochloa colona (L.) Link] with resistance to four herbicides, imazamox, fenoxaprop-P-ethyl, quinclorac, and propanil, each representing a different mechanism of action, was identified in Sunflower County, MS. Dose responses were performed on the resistant biotype and a biotype sensitive to all four herbicides to determine the level of resistance. Application of a cytochrome P450 inhibitor, malathion, with the herbicides imazamox and quinclorac resulted in increased susceptibility in the resistant biotype. Differential gene expression analysis of resistant and sensitive plants revealed that 170 transcripts were upregulated in resistant plants relative to sensitive plants and 160 transcripts were upregulated in sensitive plants. In addition, 507 transcripts were only expressed in resistant plants and 562 only in sensitive plants. A subset of these transcripts were investigated further using quantitative PCR (qPCR) to compare gene expression in resistant plants with expression in additional sensitive biotypes. The qPCR analysis identified two transcripts, a kinase and a glutathione S-transferase that were significantly upregulated in resistant plants compared with the sensitive plants. A third transcript, encoding an F-box protein, was downregulated in the resistant plants relative to the sensitive plants. As no cytochrome P450s were differentially expressed between the resistant and sensitive plants, a single-nucleotide polymorphism analysis was performed, revealing several nonsynonymous point mutations of interest. These candidate genes will require further study to elucidate the resistance mechanisms present in the resistant biotype.
Soybean consultants from Arkansas, Louisiana, southeast Missouri, Mississippi, and Tennessee were surveyed in 2016 to assess weed management practices and the prevalence of herbicide-resistant weeds in midsouthern U.S. soybean production. The consultants surveyed represented 13%, 28%, 8%, 16%, and 5% of the total soybean area planted in Arkansas, Louisiana, southeast Missouri, Mississippi, and Tennessee, respectively. Of the total scouted area, 78% of the consultants said their growers planted glyphosate-resistant soybean in 2016, with 18% planting glufosinate-resistant (LibertyLink®), primarily due to familiarity with and cost of the technology. Although 94% of the consultants determined that glufosinate was most effective on killing Palmer amaranth, the primary concern associated with controlling herbicide-resistant weeds was the associated cost, followed by return profit and time constraints. Palmer amaranth, morningglory species, horseweed, barnyardgrass, and Italian ryegrass were the five most problematic weeds in soybean across the five states. Palmer amaranth was the most problematic and important weed in each state individually. The increased concern (77% of consultants) with this species was attributed to the rising concern with and occurrence of protoporphyrinogen oxidase–resistant Palmer amaranth. Consultants were of the opinion that more research was needed on cover crops and the new traited technologies in order to improve weed management in soybean.
Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients.
Methods:
A total of 137 patients, aged 2–50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected.
Results:
Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p = 0.005), 2 (p = 0.006) and 3 (p = 0.010). Mean pain scores were also significantly lower in the Coblation group (p = 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p < 0.001).
Conclusion:
Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.