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Cancer patients often suffer from refractory symptoms near death. The use of sedatives aims to relieve suffering caused by these symptoms. The practice varies broadly. The aim of this study was to evaluate the role and trends of midazolam use in cancer patients dying in a university hospital oncology ward.
Methods
The study population of this retrospective registry-based study consists of patients who died in a university hospital oncology ward in Eastern Finland in 2010–2018 (n = 639). Information about treatment decisions, midazolam use, and background factors were gathered.
Results
During the study period, 14.7 % of the patients dying in the ward received midazolam with sedative intent prior to death. 4.7 % (n = 30) of the whole study population had continuous infusion and the rest of the midazolam use was one or multiple single doses. Documented discussion of possible palliative sedation (PS) use was found in almost one third of all patients. Out of those, eventually receiving midazolam with sedative intent, two thirds had had this discussion. The most common symptoms leading to midazolam were dyspnea, pain, and delirium. In continuous use the median midazolam infusion rate was 4.0 mg/h. The continuous infusion started median of 23.25 h and multiple single doses 19 h before death. If only one dose of midazolam was needed, it was given median of 30 minutes prior to death and the most common symptom was dyspnea. Those who received midazolam were more likely to be younger (p = 0.003) and had had a palliative outpatient clinic visit (p = 0.045).
Significance of results
This is the first study to report the trends and practices of midazolam use for refractory symptoms in Finland. Midazolam was used for approximately every 7th dying cancer patient. Applying midazolam was supported by a history of palliative clinic visits and younger age.
The interaction of a solitary wave and a slowly varying mean background or flow for the Serre-Green-Naghdi (SGN) equations is studied using Whitham modulation theory. The exact form of the three SGN-Whitham modulation equations – two for the mean horizontal velocity and depth decoupled from one for the solitary wave amplitude field – is obtained in the solitary wave limit. Although the three equations are not diagonalizable, the restriction of the full system to simple waves for the mean equations is diagonalized in terms of Riemann invariants. The Riemann invariants are used to analytically describe the head-on and overtaking interactions of a solitary wave with a rarefaction wave and dispersive shock wave (DSW), leading to scenarios of solitary wave trapping or transmission by the mean flow. The analytical results for overtaking interactions prove that a simpler, approximate approach based on the DSW fitting method is accurate to the second order in solitary wave amplitude, beyond the first order accurate Korteweg-de Vries approximation. The analytical results also accurately predict the SGN DSW’s solitary wave edge amplitude and speed. The analytical results are favourably compared with corresponding numerical solutions of the full SGN equations. Because the SGN equations model the bi-directional propagation of strongly nonlinear, long gravity waves over a flat bottom, the analysis presented here describes large amplitudesolitary wave-mean flow interactions in shallow water waves.
The overexploitation of wildlife for bushmeat consumption poses a significant threat to biodiversity in sub-Saharan Africa, particularly in Angola, where the problem remains largely unexplored. This study provides the first overview of the regional bushmeat trade in Uíge Province and an analysis of consumption patterns in this socio-economic context. We provide data on the range of species hunted and their respective conservation status, and highlight the sources and structures underlying this regional trade. We conducted qualitative expert interviews with nine bushmeat traders from four communities and a quantitative consumer survey of 204 citizens of Uíge. More than 60% of the respondents consumed bushmeat at least once per week and 23% hunted regularly, indicating that this practice is deeply rooted in society. Of the 16 species sold in the central market in Uíge, five are categorized as threatened or Near Threatened on the IUCN Red List, highlighting the need for control measures. Large parts of the population consider bushmeat consumption to be an integral part of their culture but our results indicate that younger and better educated Angolans are moving away from these traditions and are less likely to practice traditional hunting. These findings suggest that access to comprehensive education and environmentally sustainable livelihoods is key to reducing the unsustainable use of wildlife resources.
We developed a clinical care pathway for the detection and management of frailty for older adults living in long-term care (LTC) homes.
Methods
We utilized a modified Delphi with residents of LTC homes experiencing frailty, their caregivers, and care providers. The pathway was created using existing literature and input from key LTC experts.
Findings
Fifty-two panelists completed round one of the Delphi, and 55.8% of these respondents completed round two. Both rounds had high agreement and ratings. We added six new statements following analysis of round two, and 15 statements were modified/updated to reflect panelist feedback. The final pathway included 28 statements and promotes a resident-centered approach that highlights caregiver involvement and inter-professional teamwork to identify and manage frailty, as well as initiate palliative care earlier.
Conclusion
Implementing this pathway will allow health care providers to adopt screening measures and adapt care to a resident’s frailty severity.
We prove that the mapping class group is not an h-cobordism invariant of high-dimensional manifolds by exhibiting h-cobordant manifolds whose mapping class groups have different cardinalities. In order to do so, we introduce a moduli space of ‘h-block’ bundles and understand its difference with the moduli space of ordinary block bundles.
Cable-driven exoskeletons have recently shown great promise in the rehabilitation of stroke survivors. Numerical modeling/simulation provides a cost- and time-effective approach to fine-tuning design parameters of the exoskeletons, hence reducing the need for expensive and time-consuming experimental trials. This study investigated using a cable-driven lower limb rehabilitation exoskeleton (C-LREX) to correct stroke-impaired gait and track reference healthy trajectories. The impact of different levels of impairment and subject anthropometry variation on the model’s performance was studied. The C-LREX model was successful in assisting the impaired limb to track the reference trajectory in all impaired gait patterns, except for higher impairment levels (>20° range of motion deviation at the hip joint). Subject anthropometry variation did not affect trajectory tracking when the cable routing was scaled to fit the user’s anthropometry. This study confirmed that the C-LREX model could simulate various impaired lower limb gait patterns in the sagittal plane and determine the cable tension requirements needed to correct the impairment. Future work includes expanding the framework to incorporate frontal plane motion and to validate C-LREX performance in assisting biplanar impaired motion.
There are critical gaps within implementation science concerning health equity, particularly for minoritised ethnic groups. Implementation framework adaptations are important to facilitate health equity, which is especially relevant for psychiatry due to ethnic inequities in mental health; however, the range of potential adaptations has yet to be synthesised.
Aims
This systematic scoping review aimed to identify and map the characteristics of adaptations to implementation frameworks for minority ethnic groups to improve health equity.
Method
Bibliographic searches of the MEDLINE, Embase, PsycINFO and CINAHL databases were conducted, spanning the period from 2004 to February 2024 for descriptions of implementation frameworks adapted for minority ethnic groups. The characteristics of those meeting the criteria were narratively synthesised.
Results
Of the 2947 papers screened, six met the eligibility criteria. Three different types of implementation frameworks were adapted across the six papers: evaluation, process and determinant frameworks. Most of the adaptations were made by expanding the original framework, and by integrating it with another model, theory or framework with an equity focus. The adaptations primarily focused on putting equity at the forefront of all stages of implementation from intervention selection to implementation sustainability. No studies measured the effectiveness of the adapted framework.
Conclusions
The findings demonstrate that implementation frameworks are modifiable, and different elements can be adapted according to the implementation framework type. This review provides a starting point for how researchers and healthcare providers can adapt existing implementation frameworks to promote health equity for minoritised groups across a range of healthcare settings.
Childhood trauma is a well-established risk factor for psychosis, paranoia, and substance use, with cannabis being a modifiable environmental factor that exacerbates these vulnerabilities. This study examines the interplay between childhood trauma, cannabis use, and paranoia using standard tetrahydrocannabinol (THC) units as a comprehensive measure of cannabis exposure.
Methods
Data were derived from the Cannabis&Me study, an observational, cross-sectional, online survey of 4,736 participants. Childhood trauma was assessed using a modified Childhood Trauma Screen Questionnaire, while paranoia was measured via the Green Paranoid Thoughts Scale. Cannabis use was quantified using weekly standard THC units. Structural equation modeling (SEM) was employed to evaluate direct and indirect pathways between trauma, cannabis use, and paranoia.
Results
Childhood trauma was strongly associated with paranoia, particularly emotional, and physical abuse (β = 16.10, q < 0.001; β = 16.40, q < 0.001). Cannabis use significantly predicted paranoia (β = 0.009, q < 0.001). Interactions emerged between standard THC units and both emotional abuse (β = 0.011, q < 0.001) and household discord (β = 0.011, q < 0.001). SEM revealed a small but significant indirect effect of trauma on paranoia via cannabis use (β = 0.004, p = 0.017).
Conclusions
These findings highlight childhood trauma as a primary driver of paranoia, with cannabis use amplifying its effects. While trauma had a strong direct impact, cannabis played a significant mediating role. Integrating standard THC units into psychiatric research and clinical assessments may enhance risk detection and refine intervention strategies, particularly for childhood trauma-exposed individuals.
This article presents a critical postcolonial analysis of international human rights law’s engagement with human trafficking through the lens of seven UN treaty bodies. Drawing on content analysis of 1,197 documents (33 General Comments/Recommendations, 1,049 Concluding Observations, and 115 Individual Communications), the article reveals how international human rights law is implicated in the status subordination of subaltern people. The article identifies 54 documents containing evidence of colonial legacies, with 76% of relevant Concluding Observations addressing Global South states. It argues that treaty bodies reinscribe colonial patterns through problematic conflation of trafficking with slavery, promotion of repressive migration policies, inconsistent treatment of prostitution and sex tourism, perpetuation of ‘raid and rescue’ approaches, and essentialization of trafficking victims as ‘innocent’. It also exposes limited engagement with intersectionality in individual communications, potentially overlooking complex, multifaceted experiences of trafficking victims. The article concludes by proposing concrete strategies to decolonise anti-trafficking law and practice, including interrogating assumed neutrality in legal instruments, embracing a politics of recognition, integrating the concept of ‘burdened agency’, and meaningfully countenancing intersectionality in legal analyses. This analysis contributes to understanding how international human rights law can better serve its emancipatory potential while avoiding the perpetuation of status subordination.
Deep brain stimulation (DBS) is being investigated as a treatment for patients with refractory major depressive disorder (MDD). However, little is known about how DBS exerts its antidepressive effects. Here, we investigated whether ventral anterior limb of the internal capsule stimulation modulates a limbic network centered around the amygdala in patients with treatment-resistant MDD.
Methods
Nine patients underwent resting state functional magnetic resonance scans before DBS surgery and after 1 year of treatment. In addition, they were scanned twice within 2 weeks during the subsequent double-blind cross-over phase with active and sham treatment. Twelve matched controls underwent scans at the same time intervals to account for test–retest effects. The imaging data were investigated with functional connectivity (FC) analysis and dynamic causal modelling.
Results
Results showed that 1 year of DBS treatment was associated with increased FC of the left amygdala with precentral cortex and left insula, along with decreased bilateral connectivity between nucleus accumbens and ventromedial prefrontal cortex. No changes in FC were observed during the cross-over phase. Effective connectivity analyses using dynamic causal models revealed widespread amygdala-centric changes between presurgery and 1 year follow-up, while the cross-over phase was associated with insula-centric changes between active and sham stimulation.
Conclusions
These results suggest that ventral anterior limb of the internal capsule DBS results in complex rebalancing of the limbic network involved in emotion, reward, and interoceptive processing.
Weeds significantly reduce sugarcane (Saccharum officinarum L.) production by 30% to 50% and cause complete crop loss in severe cases. Guangxi, a central sugarcane-growing region in southern China, faces significant challenges due to the proliferation of weeds severely impacting crop tillering, yield, and quality. In this study, we surveyed and identified 35 weed species belonging to 16 families in Longzhou, Nongqin, and Qufeng, with significant threats posed by purple nutsedge (Cyperus rotundus L.), bermudagrass [Cynodon dactylon (L.) Pers.], hairy crabgrass [Digitaria sanguinalis (L.) Scop.], black nightshade (Solanum nigrum L.), white-edge morningglory [Ipomoea nil (L.) Roth], and ivy woodrose [Merremia hederacea (Burm. f.) Hallier f.]. The application of 81% MCPA-ametryn-diuron achieved greater than 90% control within 15 d. Although herbicides are effective, they can unintentionally harm sugarcane, indicating a need for tolerant genotypes. Therefore, we comprehensively evaluated herbicide-induced phytotoxic responses and identified tolerant sugarcane genotypes over 3 yr of trials conducted on 222 genotypes across Guangxi. We quantified phytotoxicity by counting the number and severity of affected leaves. The ANOVA revealed statistically significant main and interaction effects among genotype, crop cycle, and location. Cluster and discriminant analyses classified the genotypes into five groups: 21 highly tolerant (HT), 68 tolerant, 75 moderately tolerant, 18 susceptible, and 40 highly susceptible. The 21 HT genotypes demonstrated strong potential to be used as parental lines for breeding herbicide-tolerant varieties, to inform precision breeding strategies, and to increase tolerance to herbicide stress in sugarcane.
The Manapany day gecko Phelsuma inexpectata is a Critically Endangered species endemic to Réunion Island in the Indian Ocean. Studying its geographical distribution and its evolution is important for developing effective biodiversity conservation strategies. We evaluated past and current distributions of P. inexpectata using records from 2008–2020 and through recent, intensive field surveys (230 person-days, 2020–2022). We found that its past distribution has declined by more than 28% (5.12 ha), from 19.44 ha to 14.32 ha. In natural habitats, the distribution of P. inexpectata has been strongly affected, declining by c. 45%, but we identified new areas of occurrence (10.72 ha) through field surveys. Most of these new areas (79%) were found in anthropogenic habitats where the species had not been documented before. The current distribution of P. inexpectata covers c. 24 ha, of which 75% is located in urban areas such as gardens and green urban spaces. Moreover, our field survey showed that at least 10% of its range is now colonized by the invasive gold-dust day gecko Phelsuma laticauda. This survey provides an essential baseline for tracking the future distribution of this threatened species and its potential invasive competitor, and for monitoring how changes to its habitat affect the distribution of P. inexpectata.
Using bi-contact geometry, we define a new type of Dehn surgery on an Anosov flow with orientable weak invariant foliations. The Anosovity of the new flow is strictly connected to contact geometry and the Reeb dynamics of the defining bi-contact structure. This approach gives new insights into the properties of the flows produced by Goodman surgery and clarifies under which conditions Goodman’s construction yields an Anosov flow. Our main application gives a necessary and sufficient condition to generate a contact Anosov flow by Foulon–Hasselblatt Legendrian surgery on a geodesic flow. In particular, we show that this is possible if and only if the surgery is performed along a simple closed geodesic. As a corollary, we have that any positive skewed $\mathbb {R}$-covered Anosov flow obtained by a single surgery on a closed orbit of a geodesic flow is orbit equivalent to a positive contact Anosov flow.