New postoperative pain instrument for toddlers-Secondary analysis of prospectively collected assessments after tonsil surgery.

BACKGROUND: The Children's and Infant's Postoperative Pain Scale (CHIPPS) and the German version of the Parent's Postoperative Pain Measure (PPPM-D) are used to assess postoperative pain intensity in preschool children. However, they have shown low concordance in previous prospective studies on quality improvement. AIMS: Our secondary analysis aimed to estimate the association strength between the pain score items and indication for rescue medication defined as CHIPPS ≥4 and/or PPPD-D ≥ 6. Thus, we intended to create a further developed pain instrument with fewer variables for easier routine use. METHODS: We analyzed 1067 pain intensity assessments of hospitalized children for the development of our novel tool in two steps using modern statistical and machine-learning methods: (1) Boruta variable selection to analyze the association strength between CHIPPS score, PPPM-D items, age, weight, and elapsed time after surgery, including their interactions and pattern stability, and the binary outcome (analgesics required yes/no). (2) Symbolic regression to generate a short formula with the least number of variables and highest accuracy for rescue medication indication. RESULTS: Additional analgesics were required in 19.96% of pain intensity assessments, whereby the PPPM-D showed higher variance than CHIPPS. Boruta identified PPPM-D score, CHIPPS score, 9 of the 15 PPPM-D variables, and time of assessment as associated with the indication for RM. Symbolic regression revealed that additional analgesics are required if CHIPPS is ≥4 OR PPPM-D item "less energy than usual" AND one of the items "more easily cry" or "more groan/moan" are answered with "yes." These PPPM-D items were not redundant and showed nonlinear course over time. The cross-validated accuracy for this assessment tool was 94.94%. CONCLUSIONS: The new instrument is easy to use and may improve postoperative pain intensity assessment in children. However, it requires prospective validation in a new cohort.

Growth and reproduction of Antarctic vascular plants in response to warming and UV radiation reductions in the field.

Along the west coast of the Antarctic Peninsula springtime ozone depletion events can lead to a two-fold increase in biologically effective UV-B radiation (UV-BBE) and summer air temperatures have risen ≈1.5°C during the past 50 years. We manipulated levels of UV radiation and temperature around Colobanthus quitensis (a cushion-forming plant, Caryophyllaceae) and Deschampsia antarctica (a tussock grass) along the Peninsula near Palmer Station for two field seasons. Ambient levels of UV were manipulated by placing filters that either transmitted UV (filter control), absorbed UV-B (reducing diurnal levels of UV-BBE by about 82%), or absorbed both UV-B and UV-A (reducing UV-BBE and UV-ABE by about 88 and 78%, respectively) on frames over naturally growing plants from November to March. Half the filters of each material completely surrounded the frames and raised diurnal and diel air temperatures around plants by an average of 2.3°C and 1.3°C, respectively. Reducing UV or warming had no effect on leaf concentrations of soluble UV-B absorbing compounds, UV-B absorbing surface waxes or chlorophylls. Warming had few effects on growth of either species over the first season. However, over the second field season warming improved growth of C. quitensis, leading to a 50% increase in leaf production (P < 0.10), a 26% increase in shoot production, and a 6% increase in foliar cover. In contrast, warming reduced growth of D. antarctica, leading to a 20% decline in leaf length, a 17% decline in leaf production (P < 0.10), and a 5% decline in foliar cover. Warming improved sexual reproduction in both species, primarily through faster development of reproductive structures and greater production of heavier seeds. Over the second field season, the percentage of reproductive structures that had reached the most developed (seed) stage in C. quitensis and D. antarctica was 20% and 15% higher, respectively, under warming. Capsules of C. quitensis produced 45% more seeds under warming and these seeds were 11% heavier. Growth of D. antarctica was improved when UV was reduced and these effects appeared to be cumulative over field seasons. Over the second season, tillers produced 55% more leaves and these leaves were 32% longer when UV-B was reduced. Tillers produced 137% more leaves that were 67% longer when both UV-B and UV-A were reduced. The effects of UV reduction were not as pronounced on C. quitensis, although over the second season cushions tended to be 17% larger and produce 21% more branches when UV-B was reduced, and tended to be 27% larger and produce 38% more branches when both UV-B and UV-A were reduced (P < 0.10). Few interactions were found between UV reduction and warming, although in the absence of warming, reducing UV led to slower development of reproductive structures in both species. The effects of warming and UV reduction were species specific and were often cumulative over the two field seasons, emphasizing the importance of long-term field manipulations in predicting the impacts of climate change.