How chronic pain changes a person's life story in relation to participation in occupational roles: A narrative exploration.

BACKGROUND: Chronic pain (CP) affects a large part of the population worldwide, decreasing physical and mental health and causing a shift in occupational roles. This has created a need for a better understanding to address this problem. OBJECTIVES: To explore possible changes in occupational roles and the participation levels within among people diagnosed with CP over time. MATERIAL AND METHODS: The study used a qualitative, narrative methodology. Five people with CP were included in the study. They participated in a single-life story interview coupled with timeline drawings. Data analysis was conducted using a narrative analysis. RESULTS: The results revealed that occupational roles and the participation therein changed over time. Employee was considered the most important role, whereby the participants tried to maintain this role by sacrificing other roles within their lives. Moreover, CMP forced a change in their occupational identity. CONCLUSION: CP can disrupt a person's life and demand a change in occupational roles and the participation levels within. This process was accompanied by possible changes in their occupational identity.

Ocean circulation along the southern Chile transition region (38°-46°S): Mean, seasonal and interannual variability, with a focus on 2014-2016.

Satellite and atmospheric model fields are used to describe the wind forcing, surface ocean circulation, temperature and chlorophyll-a pigment concentrations along the coast of southern Chile in the transition region between 38° and 46°S. Located inshore of the bifurcation of the eastward South Pacific Current into the equatorward Humboldt and the poleward Cape Horn Currents, the region also includes the Chiloé Inner Sea and the northern extent of the complex system of fjords, islands and canals that stretch south from near 42°S. The high resolution satellite data reveal that equatorward currents next to the coast extend as far south as 48°-51°S in spring-summer. They also display detailed distributions of forcing from wind stress and wind stress curl near the coast and within the Inner Sea. Between 38°-46°S, both winds and surface currents during 1993-2016 change directions seasonally from equatorward during summer upwelling to poleward during winter downwelling, with cooler SST and greater surface chlorophyll-a concentrations next to the coast during upwelling, opposite conditions during downwelling. Over interannual time scales during 1993-2016, there is a strong correlation between equatorial El Niño events and sea level and a moderate correlation with alongshore currents. Looking more closely at the 2014-2016 period, we find a marginal El Niño during 2014 and a strong El Niño during 2015 that connect the region to the tropics through the oceanic pathway, with some atmospheric connections through the phenomenon of atmospheric blocking (as noted by others). The period also includes a Harmful Algal Bloom of the dinoflagellate Alexandrium catenella during early-2016 that occurred during a sequence of physical conditions (winds, currents and temperatures) that would favor such a bloom. The most anomalous physical condition during this specific bloom is an extreme case of atmospheric blocking that creates a long period of calm in austral autumn after strong upwelling in austral summer. The blocking is related to the 2015-2016 El Niño and an unusual coincident positive phase of the Southern Annular Mode.

The pelagic ecosystem in the Northern California Current off Oregon during the 2014-2016 warm anomalies within the context of the past 20 years.

A warm anomaly in the upper ocean, colloquially named "the Blob," appeared in the Gulf of Alaska during the calm winter of 2013-2014, spread across the northern North Pacific (NP) Ocean, and shifted eastward and onto the Oregon shelf. At least 14 species of copepods occurred which had never been observed in shelf/slope waters off Oregon, some of which are known to have NP Gyre affinities, indicating that the source waters of the coastal "Blob" were likely of both offshore (from the west) and subtropical/tropical origin. The anomalously warm conditions were reduced during strong upwelling in spring 2015 but returned when upwelling weakened in July 2015 and transitioned to downwelling in fall 2015. The extended period of warm conditions resulted in prolonged effects on the ecosystem off central Oregon, lasting at least through 2016. Impacts to the lower trophic levels were unprecedented and include a novel plankton community composition resulting from increased copepod, diatom, and dinoflagellate species richness and increased abundance of dinoflagellates. Additionally, the multiyear warm anomalies were associated with reduced biomass of copepods and euphausiids, high abundance of larvaceans and doliolids (indictors of oligotrophic ocean conditions), and a toxic diatom bloom (Pseudo-nitzschia) throughout the California Current in 2015, thereby changing the composition of the food web that is relied upon by many commercially and ecologically important species.

Sea level anomaly on the Patagonian continental shelf: Trends, annual patterns and geostrophic flows.

We study the annual patterns and linear trend of satellite sea level anomaly (SLA) over the southwest South Atlantic continental shelf (SWACS) between 54ºS and 36ºS. Results show that south of 42°S the thermal steric effect explains nearly 100% of the annual amplitude of the SLA, while north of 42°S it explains less than 60%. This difference is due to the halosteric contribution. The annual wind variability plays a minor role over the whole continental shelf. The temporal linear trend in SLA ranges between 1 and 5 mm/yr (95% confidence level). The largest linear trends are found north of 39°S, at 42°S and at 50°S. We propose that in the northern region the large positive linear trends are associated with local changes in the density field caused by advective effects in response to a southward displacement of the South Atlantic High. The causes of the relative large SLA trends in two southern coastal regions are discussed as a function meridional wind stress and river discharge. Finally, we combined the annual cycle of SLA with the mean dynamic topography to estimate the absolute geostrophic velocities. This approach provides the first comprehensive description of the seasonal component of SWACS circulation based on satellite observations. The general circulation of the SWACS is northeastward with stronger/weaker geostrophic currents in austral summer/winter. At all latitudes, geostrophic velocities are larger (up to 20 cm/s) close to the shelf-break and decrease toward the coast. This spatio-temporal pattern is more intense north of 45°S.

Blended sea level anomaly fields with enhanced coastal coverage along the U.S. West Coast.

We form a new 'blended' data set of sea level anomaly (SLA) fields by combining gridded daily fields derived from altimeter data with coastal tide gauge data. Within approximately 55-70 km of the coast, the altimeter data are discarded and replaced by a linear interpolation between the tide gauge and remaining offshore altimeter data. To create a common reference height for altimeter and tide gauge data, a 20-year mean is subtracted from each time series (from each tide gauge and altimeter grid point) before combining the data sets to form a blended mean sea level anomaly (SLA) data set. Daily mean fields are produced for the 22-year period 1 January 1993-31 December 2014. The primary validation compares geostrophic velocities calculated from the height fields and velocities measured at four moorings covering the north-south range of the new data set. The blended data set improves the alongshore (meridional) component of the currents, indicating an improvement in the cross-shelf gradient of the mean SLA data set.

Intra-seasonal sea level variability along the west coast of India.

The importance of local versus distant forcing is studied for the wind-driven intra-seasonal (30-120 day) sea level anomaly (SLA) variations along the west coast of India. Significant correlations of altimeter-derived SLA on the west coast are found with the mid-basin SLA east of Sri Lanka and SLA as far as Sumatra and the equator, with increased lags, connecting with the remote forcing from the equator in the form of reflected Rossby waves. The highest correlations between SLA on the west coast and winds are found with the winds at the southern tip of India. Coherence calculations help to identify the importance of a narrow band (40-60 day) for the interactions of winds with the intra-seasonal SLA variations. A multivariate regression model, along with the coherences within this narrower band, suggest the lags of SLA on the west coast with winds to range from 0 to 2 days with the local forcing to 11-13 days with the forcing along south east coast of India. Hovmöller diagrams illustrate the propagation of signals by estimating phase speed for Rossby waves (57 cm/s) across the Indian Ocean from Sumatra and Coastal Trapped Waves (CTWs) along the west coast of India (178 cm/s). Propagation from the south-east coast of India is not as robust as Rossby waves from Sumatra.

Altimeter-derived seasonal circulation on the southwest Atlantic shelf: 27°-43°S.

Altimeter sea surface height (SSH) fields are analyzed to define and discuss the seasonal circulation over the wide continental shelf in the SW Atlantic Ocean (27°-43°S) during 2001-2012. Seasonal variability is low south of the Rio de la Plata (RdlP), where winds and currents remain equatorward for most of the year. Winds and currents in the central and northern parts of our domain are also equatorward during autumn and winter but reverse to become poleward during spring and summer. Transports of shelf water to the deep ocean are strongest during summer offshore and to the southeast of the RdlP. Details of the flow are discussed using mean monthly seasonal cycles of winds, heights, and currents, along with analyses of Empirical Orthogonal Functions. Principle Estimator Patterns bring out the patterns of wind forcing and ocean response. The largest part of the seasonal variability in SSH signals is due to changes in the wind forcing (described above) and changes in the strong boundary currents that flow along the eastern boundary of the shelf. The rest of the variability contains a smaller component due to heating and expansion of the water column, concentrated in the southern part of the region next to the coast. Our results compare well to previous studies using in situ data and to results from realistic numerical models of the regional circulation.

The salinity signature of the cross-shelf exchanges in the Southwestern Atlantic Ocean: Satellite observations.

Satellite-derived sea surface salinity (SSS) data from Aquarius and SMOS are used to study the shelf-open ocean exchanges in the western South Atlantic near 35°S. Away from the tropics, these exchanges cause the largest SSS variability throughout the South Atlantic. The data reveal a well-defined seasonal pattern of SSS during the analyzed period and of the location of the export of low-salinity shelf waters. In spring and summer, low-salinity waters over the shelf expand offshore and are transferred to the open ocean primarily southeast of the river mouth (from 36°S to 37°30'S). In contrast, in fall and winter, low-salinity waters extend along a coastal plume and the export path to the open ocean distributes along the offshore edge of the plume. The strong seasonal SSS pattern is modulated by the seasonality of the along-shelf component of the wind stress over the shelf. However, the combined analysis of SSS, satellite-derived sea surface elevation and surface velocity data suggest that the precise location of the export of shelf waters depends on offshore circulation patterns, such as the location of the Brazil Malvinas Confluence and mesoscale eddies and meanders of the Brazil Current. The satellite data indicate that in summer, mixtures of low-salinity shelf waters are swiftly driven toward the ocean interior along the axis of the Brazil/Malvinas Confluence. In winter, episodic wind reversals force the low-salinity coastal plume offshore where they mix with tropical waters within the Brazil Current and create a warmer variety of low-salinity waters in the open ocean. KEY POINTS: Satellite salinity sensors capture low-salinity detrainment events from shelves SW Atlantic low-salinity detrainments cause highest basin-scale variability In summer low-salinity detrainments cause extended low-salinity anomalies.

The salinity signature of the cross-shelf exchanges in the Southwestern Atlantic Ocean: Numerical simulations.

A high-resolution model is used to characterize the dominant patterns of sea surface salinity (SSS) variability generated by the freshwater discharges of the Rio de la Plata (RdlP) and the Patos/Mirim Lagoon in the southwestern Atlantic region. We identify three dominant modes of SSS variability. The first two, which have been discussed in previous studies, represent the seasonal and the interannual variations of the freshwater plumes over the continental shelf. The third mode of SSS variability, which has not been discussed hitherto, represents the salinity exchanges between the shelf and the deep ocean. A diagnostic study using floats and passive tracers identifies the pathways taken by the freshwater plumes. During the austral winter (JJA), the plumes leave the shelf region north of the BMC. During the austral summer (DJF), the plumes are entrained more directly into the BMC. A sensitivity study indicates that the high-frequency component of the wind stress forcing controls the vertical structure of the plumes while the low-frequency component of the wind stress forcing and the interannual variations of the RdlP discharge controls the horizontal structure of the plumes. Dynamical analysis reveals that the cross-shelf flow has a dominant barotropic structure and, therefore, the SSS anomalies detected by Aquarius represent net mass exchanges between the shelf and the deep ocean. The net cross-shelf volume flux is 1.21 Sv. This outflow is largely compensated by an inflow from the Patagonian shelf.

Serum troponin Ic values in organ donors are related to donor myocardial dysfunction but not to graft dysfunction or rejection in the recipients.

BACKGROUND: Increased plasma cardiac troponin I (cTnI) values in heart donors are associated with donor myocardial dysfunction and increased risk of rejection in the recipients. We investigated the association between cTnI values and myocardial dysfunction in potential heart donors and the relationship between donors' cTnI values and recipients' early myocardial function and 1 year survival and risk of rejection. METHODS: cTnI was measured in 159 consecutive potential heart donors. Myocardial function was estimated by the left ventricular ejection fraction (LVEF) and segmental wall motion abnormalities (SWMA). Results are mean+/-SD (range) or median (interquartile range). RESULTS: cTnI values in potential donors were 2.1+/-5 ng/ml (0-40.4 ng/ml); cTnI values were significantly (P<0.001) higher: 4.2+/-5.9 ng/ml (0-30.6 ng/ml) for potential donors with LVEF <50% versus LVEF >50%: 1.7+/-4.7 ng/ml (0-40.4 ng/ml). cTnI values were significantly lower for donors without SWMA. cTnI values were significantly (P<0.001) lower for the 90 donors whose hearts were harvested: 1.1+/-2.3 ng/ml (0-15.6 ng/ml) versus the not harvested: 3.6+/-6.9 ng/ml (0-40.4 ng/ml). There were 87 recipients followed for 1 year. Donors' cTnI values were not associated with early alteration of LVEF, incidence of rejection or 1 year recipients' survival. CONCLUSION: Increased cTnI values in potential heart donors are statistically associated with myocardial dysfunction and could be helpful for organ selection. In contrast, cTnI values in heart donors were not associated with graft dysfunction or recipient survival after transplantation.

Sequential measurements of troponin Ic values in brain-dead patients considered as potential heart donors.

It was suggested that a single value of normal or increased plasma cardiac troponin T or I (cTnT or cTnI) concentration could contribute to estimate donor myocardial damage and function in brain-dead patients. In patients with acute coronary syndromes, an initial normal value of troponin must be confirmed several hours later but no such recommendations exist for brain-dead patients. We investigated the relationship between two sequential (6 h interval) measurements of plasma cTnI concentrations in brain-dead patients considered as potential heart donors. The first and the second TnIc values were correlated with an adjusted r2 value of 0.92 (p<0.001). Our results suggest therefore that it is not necessary to repeat the measurements, when the value of plasma cTnI concentration is taken into consideration in the algorithm for cardiac harvesting.

[Analysis of the criteria that contribute to the decision to harvest the heart in brain-dead organ donors]. / Analyse des critères qui participent à la décision de prélèvement cardiaque chez les patients en état de mort encéphalique.

OBJECTIVES: The number of cardiac transplantation procedures does not increase because of the lack of donor hearts despite an increase in the number of brain-dead organ donors. The criteria used to select a donor heart are not formally standardized. The aim of the present study was to analyze the criteria that contribute to the selection of a donor heart. TYPE OF STUDY: Descriptive, retrospective study. PATIENTS AND METHOD: Clinical parameters, the initial causes that lead to brain death, maximum doses of catecholamines, several biochemical markers of myocardial ischaemia/necrosis as well as several echocardiography criteria were extracted from a prospectively collected database. Univariate and multivariate (logistic regression) analyses were performed with the "harvested heart" as dependent variable and the above-cited independent variables. RESULTS: One hundred and eighty consecutive brain-dead patients admitted from 1st October 1998 to 31st December 2000 out of which 112 gave at least one organ were analyzed. Among these 112 patients, 59 (39 males and 20 females) were pre-selected as potential heart donors. Only 44 hearts were harvested. Logistic regression analysis showed that harvesting of the heart was more probable if the donor were a male, had no left ventricle systolic wall motion abnormalities, had low doses of norepinephrine and low serum troponin Ic concentrations. CONCLUSION: After an initial phase of selection, the final decision to harvest a heart is based on several criteria. These results should be an incentive to conceive a score that could allow a more formal decision process for heart harvesting.

Evaluation of donor cardiac function for heart transplantation: experience of a French academic hospital.

OBJECTIVES: The diagnostic and therapeutic approaches for evaluation and management of cardiac function in brain-dead patients vary from country to country. The aim of the present study was to describe the results of the evaluation of brain-dead patients as potential cardiac donors in a French teaching hospital that manages the largest number of brain-dead patients in France. METHODS: Demographic parameters, the causes of brain death, clinical evolution, hemodynamic parameters, doses of inotropic and/or vasopressive drugs, the results of echocardiographic examination, and several biochemical markers of myocardial cell injury were retrospectively collected. RESULTS: Seventy-one consecutive brain-dead patients admitted to the intensive care unit of the Academic Hospital of Nancy from October 1st, 1998 to September 30, 1999 were analyzed. Twenty-nine patients were considered as potential heart donors: 22 males and 7 females aged 33 +/- 3 years (Mean + SEM). The cause of brain death was head trauma in 17 cases (59%), cerebrovascular disease in 10 cases (34%), and cerebral anoxia related to cardiac arrest in 2 cases (7%). Eighteen hearts (18/29 or 66%) were harvested and transplanted with a favorable outcome at one month in 17 cases. In 11 cases, the heart was not harvested, nine (9/29 or 31%) because of myocardial dysfunction upon subsequent echocardiographic examination and 2 because of the lack of matched recipients. CONCLUSION: Comparison of these results with those of other groups suggests that hormonal substitution with insulin and triiodothyronine in the presence of myocardial dysfunction could be of potential interest to correct myocardial dysfunction and increase the number of donor hearts.

Benthic-pelagic links and rocky intertidal communities: bottom-up effects on top-down control?

Insight into the dependence of benthic communities on biological and physical processes in nearshore pelagic environments, long considered a "black box," has eluded ecologists. In rocky intertidal communities at Oregon coastal sites 80 km apart, differences in abundance of sessile invertebrates, herbivores, carnivores, and macrophytes in the low zone were not readily explained by local scale differences in hydrodynamic or physical conditions (wave forces, surge flow, or air temperature during low tide). Field experiments employing predator and herbivore manipulations and prey transplants suggested top-down (predation, grazing) processes varied positively with bottom-up processes (growth of filter-feeders, prey recruitment), but the basis for these differences was unknown. Shore-based sampling revealed that between-site differences were associated with nearshore oceanographic conditions, including phytoplankton concentration and productivity, particulates, and water temperature during upwelling. Further, samples taken at 19 sites along 380 km of coastline suggested that the differences documented between two sites reflect broader scale gradients of phytoplankton concentration. Among several alternative explanations, a coastal hydrodynamics hypothesis, reflecting mesoscale (tens to hundreds of kilometers) variation in the interaction between offshore currents and winds and continental shelf bathymetry, was inferred to be the primary underlying cause. Satellite imagery and offshore chlorophyll-a samples are consistent with the postulated mechanism. Our results suggest that benthic community dynamics can be coupled to pelagic ecosystems by both trophic and transport linkages.

[Development of antifactor VIII circulating anticoagulant after surgery of the biliary tract]. / Apparition d'un anticoagulant circulant antifacteur VIII après chirurgie de la voie biliare.

In a 25-year-old woman, admitted with a haemorrhagic syndrome following biliary surgery, an inhibitor of factor VIII was detected. As bleeding was major, she was re-operated on under perioperative administration of the anti-inhibitory coagulant complex Autoplex-T, associated with polyvalent i.v. immunoglobulins. The other therapeutic agents are also considered and their indications discussed, after a review of the circumstances of the diagnosis of this disease.

[Rhabdomyolysis after ORL surgery in prolonged lateral position]. / Rhabdomyolyse au décours d'une chirurgie ORL en décubitus latéral prolongé.

Two cases are reported of upper limb rhabdomyolysis occurring after prolonged ENT cancer surgery, the patient being part of the time in the right lateral position, with the left forearm outstretched. Surgery consisted of a vertical hemilaryngectomy with immediate parascapular free graft reconstruction in a 48-year-old man (10 h of surgery, with 6 h in a lateral position) and the surgical removal of a neoplasm involving the mouth floor and larynx in a 62-year-old man including parascapsular free graft reconstruction (10 h of surgery, with 7 h in a lateral position). In the early postoperative period, the patients complained of severe pain in the left forearm. There was a tense painful swelling of the forearm, combined with an increase in creatinine kinase plasma concentration, and myoglobinaemia. The mechanism involved was most likely a compression of the forearm muscles, together with prolonged surgery and the patient position. The part played by the state of the patients is discussed. Diagnosis must be made as soon as possible, as the only efficient treatment consists of an early fasciotomy together with the administration of alkali to avoid renal failure.

[Bacteriological relationship between organ donor and recipient. A survey apropos of 100 brain dead patients]. / Relation bactériologique entre donneur et receveur d'organes. Enquête à propos de 100 patients en état de mort cérébrale.

The aim of the study was to evaluate the relationship between germs found in samples systematically taken in the organ donors and germs found in the corresponding recipients in the 8 post-operative days. The 100 brain-dead patients received oxacillin (2g every 4 hours) when the bacteriological samples were taken. 41% of the donors were germ carriers. The germs were mainly located in the respiratory track (Staphylococcus aureus meti-S (34%) and Hemophilus (29%)). Among the 86 patients harvested, 40 donors were germ carriers and gave 132 organs, 46 donors were not germ carrier and gave 151 organs. The comparison between these two groups showed no difference. Assessment of infection occurring in organ recipient in the 8 post-operative days (germ, location, evolution) showed no difference, whether organs were removed from germ carrier donors or no. Comparison between the germs found in germ carrier donors and those found in recipients with sepsis showed a similitude in three cases (2.2%). In the other cases, there is no relationship between the germs found in the donors and post-operative sepsis in the recipient.