The spawning location of vulnerable ferox trout (Salmo trutta L.) in the Lough Corrib and Lough Mask catchments, Western Ireland.

Ferox trout are large, long-lived, piscivorous trout normally found in deep lakes; they are highly prized by trophy anglers. Lough Corrib and Lough Mask, Western Ireland, have recorded the majority of Irish specimen ferox trout since angling records began. Little was known regarding the spawning location of ferox trout relative to sympatric brown trout, and a radio telemetry study was initiated in both catchments in 2005. Over the period 2005-2009, 79 ferox were captured by angling and radio tagged in Lough Corrib, while 55 ferox were tagged in Lough Mask. Manual and helicopter tracking were carried out on all spawning streams entering both lakes over the autumn/winter period to detect tagged fish. Overall, 37 radio-tagged trout (46.8%) were detected in Lough Corrib streams and 21 tagged trout (38.2%) were recorded from Lough Mask streams. Results from radio tracking indicate that the majority (92%) of ferox trout tagged in Lough Corrib spawned in a single spawning stream, the Cong river, while the majority (76%) of ferox trout tagged in Lough Mask spawned in the Cong canal and Cong river. These results suggest that these streams are most likely the principle spawning locations of ferox trout in both lakes. The occurrence of ferox trout predominantly in single spawning rivers in both catchments highlights the vulnerability of the study ferox populations. As a result of these findings, conservation measures were introduced for ferox trout in both catchments.

Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial.

BACKGROUND: Three perioperative factors impair host defence against recurrence during cancer surgery: the surgical stress response, use of volatile anaesthetic, and opioids for analgesia. All factors are ameliorated by regional anaesthesia-analgesia. We tested the primary hypothesis that breast cancer recurrence after potentially curative surgery is lower with regional anaesthesia-analgesia using paravertebral blocks and the anaesthetic propofol than with general anaesthesia with the volatile anaesthetic sevoflurane and opioid analgesia. A second hypothesis was that regional anaesthesia-analgesia reduces persistent incisional pain. METHODS: We did a randomised controlled trial at 13 hospitals in Argentina, Austria, China, Germany, Ireland, New Zealand, Singapore, and the USA. Women (age <85 years) having potentially curative primary breast cancer resections were randomised by computer to either regional anaesthesia-analgesia (paravertebral blocks and propofol) or general anaesthesia (sevoflurane) and opioid analgesia. The primary outcome was local or metastatic breast cancer recurrence. The secondary outcome was incisional pain at 6 months and 12 months. Primary analyses were done under intention-to-treat principles. This trial is registered with ClinicalTrials.gov, NCT00418457. The study was stopped after a preplanned futility boundary was crossed. FINDINGS: Between Jan 30, 2007, and Jan 18, 2018, 2132 women were enrolled to the study, of whom 24 were excluded before surgery. 1043 were assigned to regional anaesthesia-analgesia and 1065 were allocated to general anaesthesia. Baseline characteristics were well balanced between study groups. Median follow-up was 36 (IQR 24-49) months. Among women assigned regional anaesthesia-analgesia, 102 (10%) recurrences were reported, compared with 111 (10%) recurrences among those allocated general anaesthesia (hazard ratio 0·97, 95% CI 0·74-1·28; p=0·84). Incisional pain was reported by 442 (52%) of 856 patients assigned to regional anaesthesia-analgesia and 456 (52%) of 872 patients allocated to general anaesthesia at 6 months, and by 239 (28%) of 854 patients and 232 (27%) of 852 patients, respectively, at 12 months (overall interim-adjusted odds ratio 1·00, 95% CI 0·85-1·17; p=0·99). Neuropathic breast pain did not differ by anaesthetic technique and was reported by 87 (10%) of 859 patients assigned to regional anaesthesia-analgesia and 89 (10%) of 870 patients allocated to general anaesthesia at 6 months, and by 57 (7%) of 857 patients and 57 (7%) of 854 patients, respectively, at 12 months. INTERPRETATION: In our study population, regional anaesthesia-analgesia (paravertebral block and propofol) did not reduce breast cancer recurrence after potentially curative surgery compared with volatile anaesthesia (sevoflurane) and opioids. The frequency and severity of persistent incisional breast pain was unaffected by anaesthetic technique. Clinicians can use regional or general anaesthesia with respect to breast cancer recurrence and persistent incisional pain. FUNDING: Sisk Healthcare Foundation (Ireland), Eccles Breast Cancer Research Fund, British Journal of Anaesthesia International, College of Anaesthetists of Ireland, Peking Union Medical College Hospital, Science Fund for Junior Faculty 2016, Central Bank of Austria, and National Healthcare Group.

Does residential aged care need dental professionals? A qualitative study on dental professionals' perceptions in Australia.

OBJECTIVE: Adults in residential aged care often retain their own teeth following restorative dental procedures during their lives. They may also have physical and psychological comorbidities impacting on oral health including side effects from medications. residents' poor oral hygiene, dental caries and periodontal disease raise questions about the quality of oral health care in aged care facilities. This paper presents findings from a study investigating dental professionals' perceptions of barriers and enablers to providing oral care to residents in such settings. MATERIAL AND METHODS: Following university ethics approval, semi-structured interviews were conducted with 17 dental professionals [five dentists, three oral health therapists (OHTs) and nine dental hygienists] across Australia to address the issue. Interviews were transcribed and analysed for key themes, noting similarities and differences within and between groups that were compared to existing evidence. RESULTS: Key themes emerging from interviews included individual and organisational difficulties dental professionals experience when meeting residents' oral health needs; poor access to dental resources; limited oral health education for aged care staff; and lack of interprofessional collaboration. Suggested enablers to oral health included interprofessional education and practice, reflecting broader trends in health care that positively impact on health outcomes. CONCLUSION: Improving residents' oral health requires appropriate organisational commitment to support dental and non-dental health providers deliver high-quality oral care. This study highlights the need to critically review barriers and enablers to providing such care, particularly as Australia's ageing population increases and longer periods are spent in residential aged care.

Genetic structure of pike (Esox lucius) reveals a complex and previously unrecognized colonization history of Ireland.

AIM: We investigated genetic variation of Irish pike populations and their relationship with European outgroups, in order to elucidate the origin of this species to the island, which is largely assumed to have occurred as a human-mediated introduction over the past few hundred years. We aimed thereby to provide new insights into population structure to improve fisheries and biodiversity management in Irish freshwaters. LOCATION: Ireland, Britain and continental Europe. METHODS: A total of 752 pike (Esox lucius) were sampled from 15 locations around Ireland, and 9 continental European sites, and genotyped at six polymorphic microsatellite loci. Patterns and mechanisms of population genetic structure were assessed through a diverse array of methods, including Bayesian clustering, hierarchical analysis of molecular variance, and approximate Bayesian computation. RESULTS: Varying levels of genetic diversity and a high degree of population genetic differentiation were detected. Clear substructure within Ireland was identified, with two main groups being evident. One of the Irish populations showed high similarity with British populations. The other, more widespread, Irish strain did not group with any European population examined. Approximate Bayesian computation suggested that this widespread Irish strain is older, and may have colonized Ireland independently of humans. MAIN CONCLUSIONS: Population genetic substructure in Irish pike is high and comparable to the levels observed elsewhere in Europe. A comparison of evolutionary scenarios upholds the possibility that pike may have colonized Ireland in two 'waves', the first of which, being independent of human colonization, would represent the first evidence for natural colonization of a non-anadromous freshwater fish to the island of Ireland. Although further investigations using comprehensive genomic techniques will be necessary to confirm this, the present results warrant a reappraisal of current management strategies for this species.

The association of serum vitamin D concentration with serious complications after noncardiac surgery.

BACKGROUND: Vitamin D deficiency is a global health problem. Epidemiological studies demonstrate that vitamin D is both cardioprotective and neuroprotective. Vitamin D also plays a substantial role in innate and acquired immunity. Our goal was to evaluate the association of serum vitamin D concentration on serious postoperative complications and death in noncardiac surgical patients. METHODS: We retrospectively analyzed the data of 3509 patients who had noncardiac surgery at the Cleveland Clinic Main Campus and had a serum vitamin D measurement. The relationship between serum vitamin D concentration and all-cause in-hospital mortality, in-hospital cardiovascular morbidity, and serious in-hospital infections was assessed as a common effect odds ratio (OR) by using a multivariate generalized estimating equation model with adjustment for demographic, medical history variables, and type and duration of surgery. RESULTS: Higher vitamin D concentrations were associated with decreased odds of in-hospital mortality/morbidity (P = 0.003). There was a linear reduction of the corresponding common effect odds ratio (OR 0.93, 95% confidence interval, 0.88-0.97) for severe in-hospital outcomes for each 5 ng/mL increase in vitamin D concentration over the range from 4 to 44 ng/mL. In addition, we found that the odds versus patients with vitamin D <13 ng/mL (i.e., 1st quintile) were significantly lower in patients with vitamin D 13-20, 20-27, 27-36, and > 36 ng/mL (i.e., 2nd-5th quintiles); the corresponding estimated ORs were 0.65 (99% confidence interval, 0.43-0.98), 0.53 (0.35-0.80), 0.44 (0.28-0.70), and 0.49 (0.31-0.78), respectively. However, there was no statistically significant difference among individual quintiles >13 ng/mL. CONCLUSIONS: Vitamin D concentrations were associated with a composite of in-hospital death, serious infections, and serious cardiovascular events in patients recovering from noncardiac surgery. While causality cannot be determined from our retrospective analysis, the association suggests that a large randomized trial of preoperative vitamin D supplementation and postoperative outcomes is warranted.

Low vitamin D concentration is not associated with increased mortality and morbidity after cardiac surgery.

OBJECTIVE: To determine the effect of vitamin D on postoperative outcomes in cardiac surgical patients. DESIGN: Retrospective study. SETTING: Single institution-teaching hospital. PARTICIPANTS: Adult cardiac surgical patients with perioperative 25-hydroxyvitamin D measurements. INTERVENTIONS: None. We gathered information from the Cardiac Anesthesiology Registry that was obtained at the time of the patients' visit/hospitalization. MEASUREMENTS AND MAIN RESULTS: We used data of 18,064 patients from the Cardiac Anesthesiology Registry; 426 patients with 25-hydroxyvitamin D measurements met our inclusion criteria. Association with Vitamin D concentration and composite of 11 cardiac morbidities was done by multivariate (i.e., multiple outcomes per subject) analysis. For other outcomes separate multivariable logistic regressions and adjusting for the potential confounders was used. The observed median vitamin D concentration was 19 [Q1-Q3∶12, 30] ng/mL. Vitamin D concentration was not associated with our primary composite of serious cardiac morbidities (odds ratio [OR], 0.96; 95% CI, 0.86-1.07). Vitamin D concentration was also not associated with any of the secondary outcomes: neurologic morbidity (P = 0.27), surgical (P = 0.26) or systemic infections (P = 0.58), 30-day mortality (P = 0.55), or length of initial intensive care unit (ICU) stay (P = 0.04). CONCLUSIONS: Our analysis suggests that perioperative vitamin D concentration is not associated with clinically important outcomes, likely because the outcomes are overwhelmingly determined by other baseline and surgical factors.

The effect of perioperative intravenous lidocaine and ketamine on recovery after abdominal hysterectomy.

BACKGROUND: Perioperative ketamine infusion reduces postoperative pain; perioperative lidocaine infusion reduces postoperative narcotic consumption, speeds recovery of intestinal function, improves postoperative fatigue, and shortens hospital stay. However, it is unknown whether perioperative IV lidocaine and/or ketamine enhances acute functional recovery. We therefore tested the primary hypothesis that perioperative IV lidocaine and/or ketamine in patients undergoing open abdominal hysterectomy improves rehabilitation as measured by a 6-minute walk distance (6-MWD) on the second postoperative morning. METHODS: Women having open hysterectomy were anesthetized with sevoflurane, followed by patient-controlled morphine. Patients were factorially randomized to one of the following groups: (1) lidocaine and placebo, (2) placebo and ketamine, (3) placebo and placebo, or (4) lidocaine and ketamine. Lidocaine was given as a bolus (1.5 mg/kg), followed by lidocaine infusion of 2 mg/kg/h for the first 2 hours, and then 1.2 mg/kg/h for 24 postoperative hours. Ketamine was given as a bolus (0.35 mg/kg), followed by ketamine infusion of 0.2 mg/kg/h for the first 2 hours, and then 0.12 mg/kg/h for 24 postoperative hours. The primary double-blind outcome was 6-MWD on the second postoperative morning; secondary outcomes included pain scores, opioid consumption, postoperative nausea and vomiting, and fatigue score. RESULTS: The study was stopped after a planned interim analysis of 64 patients showed that lidocaine crossed the preplanned futility boundary, with mean ± SD of 202 ± 66 m versus 202 ± 73 m for lidocaine versus placebo, respectively, and mean difference (interim adjusted 97.5% confidence interval) of 0.93 m (-52, 54) (P = 0.96); the ketamine effect also crossed the futility boundary, with mean ± SD of 193 ± 77 m versus 210 ± 61 m for ketamine versus placebo, respectively, and mean difference (interim adjusted 97.5% confidence interval) of -11 m (-65, 44) (P = 0.54). No interaction between the 2 intervention effects was observed (P = 0.96). Neither intervention significantly influenced any of the secondary outcomes. CONCLUSION: Our results do not support use of lidocaine or ketamine for improving 6-MWD on the second postoperative day after open hysterectomy.

A time-motion economic analysis of postoperative nausea and vomiting in ambulatory surgery.

BACKGROUND: One-third of surgical outpatients experience postoperative nausea and vomiting (PONV) during their hospital stay or post-discharge nausea and vomiting (PDNV) after hospitalization. We determined the incremental costs of PONV/PDNV in ambulatory patients with this time-and-motion study. METHODS: In 100 ambulatory surgery patients, we evaluated the incidence of PONV, time staff spent with patients, use of PONV-related supplies, recovery duration, PONV rescue treatments, and quality-of-life through to the third postoperative morning. Patients with and without PONV/PDNV were compared in relation to PONV-related cost after adjusting for age, American Society of Anesthesiologists status, body mass index, and duration and complexity of surgery. RESULTS: Thirty-seven percent of the patients experienced PONV during hospitalization; this increased to 42% by the first postoperative morning and increased further to 49% by the third postoperative morning. Patients with PONV spent one hour longer in the postanesthesia care unit than patients without PONV (median [interquartile range] 234 [188-287] min vs 171 [144-212] min, respectively; P = 0.001). The amount of nursing time required for patients with PONV was significantly greater than that required for patients without PONV (82 [63-106] min vs 68 [57-79] min, respectively; P = 0.02). The total cost of postoperative recovery was significantly greater for patients with PONV/PDNV than for those without (US$730 vs $640, respectively; P = 0.006). Postoperative nausea and vomiting/PDNV was associated with an adjusted incremental total cost of $75 (95% confidence interval $67 to $86). Postoperative nausea and vomiting was also associated with worsened postoperative quality of life (49% of patients with PONV/PDNV rated quality high in four domains vs 94% of patients without PONV/PDNV; P < 0.001). CONCLUSION: Postoperative nausea and vomiting/PDNV were common; they impaired quality of life and imposed an incremental cost of $75 per patient. This incremental cost is comparable with the cost patients are willing to pay to avoid PONV.

Hybridisation between two cyprinid fishes in a novel habitat: genetics, morphology and life-history traits.

BACKGROUND: The potential role hybridisation in adaptive radiation and the evolution of new lineages has received much recent attention. Hybridisation between roach (Rutilus rutilus L.) and bream (Abramis brama L.) is well documented throughout Europe, however hybrids in Ireland occur at an unprecedented frequency, often exceeding that of both parental species. Utilising an integrated approach, which incorporates geometric morphometrics, life history and molecular genetic analyses we identify the levels and processes of hybridisation present, while also determining the direction of hybridisation, through the analysis of mitochondrial DNA. RESULTS: The presence of F2 hybrids was found to be unlikely from the studied populations, although significant levels of backcrossing, involving both parental taxa was observed in some lakes. Hybridisation represents a viable conduit for introgression of genes between roach and bream. The vast majority of hybrids in all populations studied exhibited bream mitochondrial DNA, indicating that bream are maternal in the majority of crosses. CONCLUSIONS: The success of roach x bream hybrids in Ireland is not due to a successful self reproducing lineage. The potential causes of widespread hybridisation between both species, along with the considerations regarding the role of hybridisation in evolution and conservation, are also discussed.

Oral health and access to dental care: a qualitative investigation among older people in the community.

OBJECTIVE: The aim of this study was to explore older persons' beliefs and attitudes towards oral health and access to and use of dental care services. BACKGROUND: As the proportion of dentate older people increases, the need and demand for dental services will rise (J Public Health Dent, 60, 2000, 276). DESIGN: Focus groups and semi-structured interviews were used for data collection. SETTING AND SUBJECTS: The study participants included 63 older people in Perth, WA. RESULTS: Five major themes emerged from the interviews - the need for information and knowledge; accessibility of services; cost and affordability of oral care; fear and anxiety regarding dental visits and relationships with dentists. Attitudes and behaviours were slow to change in this group. CONCLUSION: This investigation provided important perspectives regarding oral health and dental access for older people residing in the community and demonstrated the importance of understanding this group when considering provision and use of services.

Oral health care issues in aged care facilities in Western Australia: resident and family caregiver views.

OBJECTIVE: To investigate resident and family perceptions and attitudes towards oral health care and access to dental services for aged care facility residents. METHOD: Focus groups and individual interviews with residents and family caregivers were conducted at aged care facilities in the Perth Metropolitan Area, Western Australia. RESULTS: There were 30 participants from twelve aged care facilities (21 residents and nine family caregivers). Five focus groups comprising both residents and family caregivers were conducted in addition to three face-to-face interviews with residents. Both groups considered oral health very important to overall health and quality of life. Family caregivers noted a lack of dental check-ups and specialised professional oral care, particularly in high-care facilities. Low care residents were more likely to have regular dental check-ups or dental treatment and off-site dental visits were straightforward due to their mobility and family member assistance. Family caregivers noted time limitations and lack of expertise in oral health care amongst staff in high-care facilities, and the challenges of maintaining oral care for residents with poor mobility or cognitive impairment. It was considered important that staff and management liaise with family caregivers and family members in provision of oral care. CONCLUSION: Regular oral care, assessment and treatment were considered limited, particularly for residents in high care. There is a need for comprehensive, ongoing oral health programmes involving appropriately trained and empathetic dental health professionals and staff to improve oral health care in Perth's aged care facilities.

Hyperthermia during anaesthesia and intensive care unit stay.

Nosocomial hyperthermia (fever) occurs in about 30% of all medical patients at some time during their hospital stay. In patients admitted to the intensive care unit with severe sepsis the incidence of hyperthermia is greater than 90%, while in a specialized neurological critical care unit the incidence is reported as 47%. In contrast, hyperthermia during anaesthesia is rare owing to the impairment of thermoregulation by anaesthetic agents. This article is designed to give an overview on the various causes of hyperthermia with special emphasis on fever during general and regional anaesthesia in general and neurological critical care patients.

Aged care staff perspectives on oral care for residents: Western Australia.

OBJECTIVE: To determine manager and staff perceptions of oral health and dental service issues for residents in aged care facilities in the Perth Metropolitan Area, Western Australia. DESIGN: Focus groups and face-to-face semi-structured interviews with aged care facility managers and staff. SETTING AND SUBJECTS: Personnel at 12 facilities (high-level and low-level care) located in the Perth Metropolitan Area participated in the study. Interviews were conducted with 14 facility managers. Focus groups and face-to-face interviews were conducted with 40 facility staff. RESULTS: Managers and staff had similar views regarding most issues. While resident oral health was considered important, regular oral care programmes were limited or lacking. In general, high care facility residents did not have regular dental checkups, while those in low-level care facilities usually visited their own dentist for checkups or treatment. Barriers to maintaining regular oral care included: resident noncompliance; financial concerns; lack of co-operation from family; mobility issues; and lack of interest from dental professionals. Suggested improvements to current services included regular on-site visits, staff education and specialised dental professionals. CONCLUSION: Residents face many barriers to maintenance of adequate oral health care, particularly those who are functionally dependent and cognitively impaired. There is an urgent need for appropriate oral care programmes for aged care residents, which include dentists with aged care experience and continuing education for facility staff. Any major programmes should be evaluated carefully.

Dental visits in older Western Australians: a comparison of urban, rural and remote residents.

OBJECTIVE: It has been reported that the aged in rural areas may not access regular dental care. The aim of this study was to describe dental visits for those 60 years of age and older living in urban, rural and remote locations in Western Australia and to determine factors associated with such visits. The main outcome was having had a dental visit in the previous 12 months. DESIGN: A cross-sectional telephone survey was conducted. SETTING: Urban, rural and remote locations in Western Australia. SUBJECTS: A total of 2100 participants, 60 years of age and older. RESULTS: The present study demonstrated that people in rural and remote areas of Western Australia had a longer time since their last dental visit than people in urban areas. Within each sex, age, country of birth, income, occupation and education group, the highest proportion of people having attended a dentist in the previous 12 months was in urban areas and the lowest was in remote areas. Controlling for sex, age, education and oral health status, compared to urban residents, rural residents were 14% less likely to have seen a dentist and remote residents were 27% less likely. CONCLUSION: The present study demonstrated that for the aged sector of the Western Australian population, geographical location is a major factor in the frequency of use of dental services and the reasons for dental visits. This raises concerns that improvement of oral health by prevention and early detection of tooth and gum problems is less likely to occur in rural and remote areas than in urban areas.