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BackgroundIn pre-hospital setting, airway management may be required during hems transportation, when patients deteriorate while en route. Our primary objective was to assess whether in-flight indirect laryngoscopy in frontal right-lateral sitting position (FP) of the operator, is such effective as traditional indirect laryngoscopy methods onshore, considering, also, the association of success rate with influencing flight factors (flying, devices, position, comfort VAS, Lumen VAS). MethodsThis observational prospective study, aimed to estimate the success rate of in-flight FP indirect laryngoscopy intubation. The study conducted on an AW 169 helicopter (©Leonardo Company, Italy) equipped with transversal stretcher, during steady flight. Indirect laryngoscopy devices (GlideScope Ranger and AirTraq) were used on a HAL® manikin (Accurate, Gaumard® Scientific Company,Inc) with cervical collar. ResultsAll of the FP intubations with both devices were successful after two attempts maximum. The mean time for intubation was slightly greater using the Glide Scope Ranger (mean 45.4±32.2”) compared to AirTraq (mean 34.8±26.7”). ConclusionsBoth AirTraq and GlideScope Ranger used in in-flight FP guarantee a comparable level of effectiveness to traditional onshore method with 100% successful rate of intubation, Airtraq seems not been affected by Lumen, indicating that in this specific contest it guarantees a high visualisation regardless the light conditions. On the other hand, the FP results effective using AirTraq in both conditions.

Chiara Angeletti,1 Paolo Matteo Angeletti,2 Martina Paesani,1 Cristiana Guetti,3 Aglaia Gyra,2 Gianluca Perseo,1 Alessandra Ciccozzi,2 Franco Marinangeli,2 Emma Altobelli4 1Operative Unit of Anaesthesiology, Intensive Care and Pain Medicine, Civil Hospital G. Mazzini of Teramo, Teramo, Italy; 2Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy; 3Emergency Department, Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; 4Department of Life, Health and Environmental Sciences, Epidemiology and Biostatistics Unit, AUSL Teramo, University of L’Aquila, L’Aquila, ItalyCorrespondence: Chiara AngelettiCivil Hospital G. Mazzini of Teramo, Piazza Italia 1, Teramo 64100, ItalyTel +39 0861429320Fax +39 0861429319Email chiara.angeletti@gmail.comPurpose: Pain is a symptom that should be evaluated along with its comorbidities in order to plan an effective holistic treatment strategy involving specific pharmacological interventions, side effect management, psychological support, control of therapeutic effects over time, and dialogue with the patient and their relatives. In this holistic process of caring for patients with pain, nurses play a central role as they deal with suffering patients directly and continuously. The purpose of this study was to evaluate the types of pain identified by nurses in their daily clinical practice and the associated comorbidities (anamnestic history taking) by geographical region and to evaluate the pharmacological strategies used.Methods: A cross-sectional survey was performed among 696 registered nurses in Italy. Data were collected using an online questionnaire.Results: There was a significant difference between geographical regions in terms of reports of acute and chronic pain: acute pain was more frequently reported in the South (63.5%), while chronic pain was more frequent in the Central region (32.3%; p=0.0008). Additionally, chronic oncological pain was more frequent in the Northeast (29.6%), while chronic non-oncological pain was more frequently reported in the Central region (33.9%; p=0.0001). The underlying pain disorders reported were also different between geographical regions; rheumatic pain (21.8%) and neurological pain (18.6%) were more frequent in the Central region, while musculoskeletal pain was significantly more frequent in the South (43.4%; p=0.004). Anxiety, sleep disorders and somatization were found in acute pain (60.82%, 43.56% and 53.12%), while depression and mood disorders were more frequently detected in chronic pain condition (p< 0.001).Conclusion: Our study showed differences among Italian regions in pain assessment. Specific education on pain management nursing is essential for nurses. Promotion of optimal nursing care for people affected by pain is the main focus of pain management nursing. Nowadays, nurses should focus on personalized complex care and research in order to improve the patient’s quality of life.Keywords: pain management, nurse education, psychological comorbidities

This study evaluated the efficacy and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with DSM-IV personality disorders (PD). Twenty-seven patients with PD were randomized to treatment with ISTDP or a minimal-contact, delayed-treatment control condition. ISTDP-treated patients improved significantly more than controls on all primary outcome indices, reaching the normal ranges on both the brief symptom inventory (1.51-0.51, p < 0.001) and inventory of interpersonal problems (1.56-0.67, p < 0.001). When control patients were treated, they experienced benefits similar to the initial treatment group. In long-term follow-up, the whole group maintained their gains and had an 83.3% reduction of personality disorder diagnoses. Treatment costs were thrice offset by reductions in medication and disability payments. This preliminary study of ISTDP suggests it is efficacious and cost-effective in the treatment of PD. Limitations of this study and suggestions for future research are discussed.

Both European Pharmacopoeia Monograph 01/2008:0447 "Canine Leptospirosis vaccine (inactivated)" and the more recent Monograph 01/2008:1939 "Bovine Leptospirosis vaccine (inactivated)" explicitly allow for a sero-response test to assess batch potency. Test setup and requirements for in vivo and in vitro validation are described. Furthermore, the two main strategies to assess batch potency and their specific demands are addressed.

Pyridinium N-Phenoxide Betaines and Their Application for the Characterization of Solvent Polarities, XVI1). – Determination of the Empirical Parameters of Solvent Polarity ET(30) and AN for 55 Substituted Phenols By means of the negatively solvatochromic dyes 1 and 2, the empirical solvent polarity parameters ET(30) and AN (Acceptor Number) are determined for solutions of 55 substituted phenols in 1,2-dichloroethane as inert solvent (Table 1). The ET(30) values and Acceptor Numbers are compared with each other and with corresponding literature values, determined in neat substituted phenols (Table 2). The influence of the phenolic substituents on both solvent parameters is discussed with respect to their electronic and steric effects as well as to the self-association of phenols in solution. Polyhydroxybenzenes such as resorcinol and pyrogallol exhibit both high solvent polarity and acceptor properties, whereas substituents in positions 2 and 6 of phenols decrease their polarity and acceptor strength.

Three chronically paratuberculosis infected herds were tested for six years twice a year (intradermal Johnin test, antibody ELISA (IDEXX Corp.), microbial culture) according to a sanitary program. Culling of shedding animals and vaccination of calves with NEOPARASEC (Merial Corp.) were part of the program. In course of experiment, 1015 samples of 228 non vaccinated cows and 1502 samples of 293 vaccinated cattle have been tested. 3.8% of the vaccinated animals proved positive in microbial culture. Nearly all vaccinated calves developed granulomas sized from hazelnut to loaf at the injection site. Positive reactions in intradermal test as well as in antibody ELISA were found in very young calves. 24.3%, 33.7%, 25.9%, respectively of the non vaccinated animals were identified as shedders of M. avium subsp. paratuberculosis (MAP) by microbial culture. In the first and in the second herd most shedders of MAP were found in the first herd examination (66.7%, 42.9%, respectively), whereas in the third herd they were detected in the fifth examination (31.0%). At the beginning, 17.9% of non vaccinated animals proved positive in intradermal test, 14.4% in antibody ELISA. Afterwards, the number of positive test results decreased but increased again towards the end of the experiment. 48.5% of the 66 shedders showed positive reactions in intradermal test, 57.6% in antibody ELISA, 77.3% in at least one of these both tests. Antibodies in ELISA were found in rising frequency from two years before the time of shedding. 50.0% of the shedders reacted positive in ELISA at the time of shedding. In selected shedders first positive results were found at the age of about two years. Unfortunately, only incomplete hygienic measures were realized by the farmers. Under field conditions the realisation of attending sanitary programs is difficult. MAP is spread mainly by buying of animals, therefore a certification program for paratuberculosis free herds is urgently necessary as well as an improvement of diagnostic methods.

After immunization of four calves with a live modified Mycobacterium paratuberculosis vaccine the course of the humoral and cell mediated immune reactions was studied during a 2-year clinical investigation. Furthermore, the possibility of shedding of the vaccine strain and the influence of the vaccination on the tuberculin skin test was determined. In addition to standard procedures recently developed diagnostic methods (antibody enzyme-linked immunosorbent assay, interferon-gamma test, polymerase chain reaction) were used. A cell-mediated immune reaction, reflected in an increased, specifically induced, interferon-gamma production developed much earlier (1-2 weeks post-immunization) than humoral immunity (8-16 weeks post-gamma immunization). While the increase in antibody titres was transient, declining to extremely low levels 48-60 weeks post-immunization, cell-mediated immunity remained detectable until the end of the investigation. Spread of the vaccine strain into the body and shedding were never detected during the whole course of the study except for one colon site in one calf. As late as 2 years after vaccine application positive or doubtful skin reactions against M. bovis purified protein derivative were measured, reflecting possible interference of the immunization with the diagnosis of bovine tuberculosis. At the end of the investigation, a positive cell-mediated immune reaction was detected the control animal although clinical, pathological and bacteriological examinations gave no indication for a mycobacterial infection.

The European Pharmacopoeia (Ph. Eur.) monograph on Swine Erysipelas Vaccine (inactivated) (Ph. Eur., 1997) requires the potency of each batch to be demonstrated in a mouse protection test. In this parallel-line bioassay, mice are challenged with a virulent strain of Erysipelothrix (E.) rhusiopathiae after immunisation with different doses of either the standard preparation or of the test vaccine. More than one hundred animals are necessary for the routine testing of a single batch. In previous studies (Beckmann und Cubetaler, 1994; Rosskopf-Streicher et al., 1998), we have shown that an indirect enzyme-linked immunosorbent assay (ELISA) may be used to quantify the humoral response of mice. This method can replace the challenge model for the purposes of potency testing in the following manner: Ten mice are immunised subcutaneously with 1/10 of the vaccine dose required for pig vaccination. After three weeks, the mice are bled under anaesthesia. Serum samples are pooled and the antibody content is compared to that of a reference serum. In view of animal welfare the advantages of the alternative model are obvious: A highly reduced number of animals and the replacement of challenge exposure. This includes the discontinuation of the control group with a mortality rate of 100%. A pre-validation study was initiated to evaluate the performance of the serological method. Eight laboratories used the test kits to evaluate pooled serum samples from vaccinated mice. Both the reagents and the test protocol were shown to be satisfactory. The intra- and inter-laboratory reproducibility that was achieved indicates that the method is a strong candidate for validation.