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Flight feather moult is an energetically expensive stage of the annual cycle of birds. Its timing is adjusted to other important time- and energy-demanding activities, including migration. In the vast majority of migratory birds, primary moult occurs before or after migration or moulting is suspended during migration. The Black-headed Gull is an exception: it starts moulting flight feathers at the onset of the autumn migration. The course of primary moult in this species is still poorly understood due to the difficulty in obtaining sufficient data from the entire period of flight feather replacement. In this paper, we employed digital photos taken in the field to estimate the start, variation in the start date and duration of primary moult in adult and immature Black-headed Gulls, by using the Underhill–Zucchini likelihood moult model. On average, immatures started their moult on 7 June, 25 days earlier than adults, but their moult lasted 5 days longer. Consequently, there was a 20-day difference in the end of moult – that is, on average it occurred on 16 September and 6 October in immature and adult gulls, respectively. Adults showed greater variability in the mean primary moult start date than immatures, as the beginning of flight feather replacement may depend on breeding success (earlier after breeding failure) and on breeding phenology. The overlap of primary moult and migration produces a trade-off in resource allocation between those two processes, which leads to a low number of simultaneously growing primaries and a decrease in the growth rate of the two external, heaviest flight feathers. Existing reports of a later completion of primary moult in the first half of November in this species are based on the faulty assumption that the outermost primary is always the longest, which is not the case in 34% of individuals. [ABSTRACT FROM AUTHOR]

Background: Measures of physical activity and pain‐related patient‐reported outcomes are important components of patient recovery after surgery. However, little is known about their association in the early post‐operative period. This study aims to increase this knowledge. Our primary objective was to determine the association between average pain intensity and activity (in steps) 1 week after surgery. Secondary objectives were the association of activity with other patient‐reported outcomes, age, sex, comorbidities and body mass index. Methods: Data were obtained from the PROMPT sub‐project of IMI‐PainCare. Patients after breast and endometriosis‐related surgery, sternotomy and total knee arthroplasty completed pain‐related outcomes questionnaires and wore an ActiGraph activity‐tracking device. We correlated steps with average pain intensity on post‐operative days 6 and 7. Secondary analyses were done using correlations and t‐tests. Results: In 284 cases, there was no statistically significant correlation between steps and average pain intensity. In addition, none of the 28 secondary analyses showed a statistically significant result. Conclusions: Pain‐related patient‐reported outcome measures and physical activity are separate entities. Both should be measured after surgery to assess patient recovery and to identify treatment deficiencies. Significance Statement: Measuring recovery is a multi‐dimensional challenge. After surgery, clinicians need to be aware that neither pain intensity nor activity levels tell the whole story. Each can hint to problems and treatment requirements. [ABSTRACT FROM AUTHOR]

Ana Lilia Garduño-López,1 Victor Manuel Acosta Nava,1 Lisette Castro Garcés,1 Dulce María Rascón-Martínez,2 Luis Felipe Cuellar-Guzmán,3 Maria Esther Flores-Villanueva,4 Elizabeth Villegas-Sotelo,5 Orlando Carrillo-Torres,6 Hugo Vilchis-Sámano,7 Mariana Calderón-Vidal,8 Gabriela Islas-Lagunas,9 C Richard Chapman,10 Marcus Komann,11 Winfried Meissner,11 Philipp Baumbach,11,* Ruth Zaslansky11,* 1Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición “Dr. Salvador Zubirán”, Mexico City, Mexico; 2Department of Anesthesiology, Centro Médico Nacional Siglo XXI, Mexico City, Mexico; 3Department of Anesthesiology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico; 4Department of Anesthesiology, Hospital General Regional No. 2” Dr. Guillermo Fajardo Ortíz” IMSS (Villacoapa), Mexico City, Mexico; 5Department of Anesthesiology, Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General “Dr. Ruben Leñero”, Mexico City, Mexico; 6Department of Anesthesiology Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico; 7Department of Orthopedics & Traumatology, Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia Lomas Verdes (IMSS), Mexico City, Mexico; 8Department of Anesthesiology Fundación Médica Sur, Mexico City, Mexico; 9Department of Anesthesiology Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico; 10Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA; 11Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany*These authors contributed equally to this workCorrespondence: Ruth ZaslanskyDepartment of Anaesthesiology and Intensive Care, University Hospital Jena, Erlanger Allee 101, Jena, D 07740, GermanyTel +49 1573 4955841Fax + 49 3641 9323112Email ruth.zaslansky@med.uni-jena.deObjective: This was a pre–post study in a network of hospitals in Mexico-City, Mexico. Participants developed and implemented Quality Improvement (QI) interventions addressing perioperative pain management.Methods: PAIN OUT, an international QI and research network, provided tools for web-based auditing and feedback of pain management and patient-reported outcomes (PROs) in the clinical routine. Ward- and patient-level factors were evaluated with multi-level models. Change in proportion of patients reporting worst pain ≥ 6/10 between project phases was the primary outcome.Results: Participants created locally adapted resources for teaching and pain management, available to providers in the form of a website and a special issue of a national anesthesia journal. They offered teaching to anesthesiologists, surgeons, including residents, and nurses. Information was offered to patients and families. A total of 2658 patients were audited in 9 hospitals, between July 2016 and December 2018. Participants reported that the project made them aware of the importance of: training in pain management; auditing one’s own patients to learn about PROs and that QI requires collaboration between multi-disciplinary teams. Participants reported being unaware that their patients experienced severe pain and lacked information about pain treatment options. Worst pain decreased significantly between the two project phases, as did PROs related to pain interfering with movement, taking a deep breath/coughing or sleep. The opportunity of patients receiving information about their pain treatment options increased from 44% to 77%.Conclusions: Patients benefited from improved care and pain-related PROs. Clinicians appreciated gaining increased expertise in perioperative pain management and methods of QI.Keywords: acute pain, surgery, quality improvement, perioperative pain management, patient-reported outcomes, auditing

The effects of recent climate change on the phenology of avian breeding and migration, geographical range shifts, and decreasing migration distances are well documented. Only a few studies have focused on the long-term influence of these changes on the body condition of migrants, which is important as it is likely to affect the fitness of the whole population. Eurasian blackcaps have adapted their migratory behaviour to changing ecological factors. These changes seem to favour the species and its migratory populations have increased over the last decades in Europe. In the present study, we analysed the body condition index of juvenile blackcaps at their stop-over site in the southern Baltic region during autumn migration from 1967 to 2006. This index was distinctly higher since the 1990s than in the middle of the 1960s, when the number of migrating blackcaps was at least twofold lower. Moreover, there was a reduction in recapture rates of blackcaps from 14% to 6% during these periods which may imply that warblers were staying for a shorter time at the stop-over site as their body condition was higher. We hypothesized that higher berry crop availability resulted in the higher condition of migrating blackcaps. Body condition index also reflecting fuel load in migrants was higher in long-distance blackcaps compared to the short-distance ones. As the former are time-minimizing migrants, their higher body condition/fuel load may allow them to migrate faster to wintering grounds in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

The species-specific and age-related autumn migration strategies of the sedge, reed and great reed warbler were investigated at stopover sites between central Europe and north-eastern Africa during autumn. Adult reed warblers accumulated larger fat reserves than juveniles and consequently were able to cover longer distances from most stopover sites. Juvenile sedge warblers, on the other hand, left Europe with significantly larger fat reserves than adults as opposed to the populations migrating along the western route. Both juvenile and adult great reed warblers were potentially able to make long flights without refuelling from the northern part of the Mediterranean region onwards. It was the proximity of large ecological barriers that had the most prominent influence on the potential flight distances of adult and juvenile Acrocephalus warblers during their southward migration. In reed and sedge warblers, the differences in mean flight distances covered by adults and juveniles were the largest (ca. 600 km) just before the crossing of the Mediterranean Sea, but smaller (ca. 200 and 400 km, respectively) in front of the Sahara Desert. Juvenile and adult great reed warblers were potentially able to cover 1660 km from Turkey, which was also supported by very low numbers of individuals caught at the Egyptian ringing sites. The results of this study carried out in the key regions of the eastern European–African flyway documented that migration strategies differed between adults and juveniles of three long-distance migrant species, yet this variation depended on the migration stage and the proximity of natural ecological barriers. [ABSTRACT FROM AUTHOR]

BACKGROUND Lixisenatide, a glucagon-like peptide-1 receptor agonist used for the treatment of diabetes, has shown neuroprotective properties in a mouse model of Parkinson's disease. METHODS In this phase 2, double-blind, randomized, placebo-controlled trial, we assessed the effect of lixisenatide on the progression of motor disability in persons with Parkinson's disease. Participants in whom Parkinson's disease was diagnosed less than 3 years earlier, who were receiving a stable dose of medications to treat symptoms, and who did not have motor complications were randomly assigned in a 1:1 ratio to daily subcutaneous lixisenatide or placebo for 12 months, followed by a 2-month washout period. The primary end point was the change from baseline in scores on the Movement Disorder Society--Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III (range, 0 to 132, with higher scores indicating greater motor disability), which was assessed in patients in the on-medication state at 12 months. Secondary end points included other MDS-UPDRS subscores at 6, 12, and 14 months and doses of levodopa equivalent. RESULTS A total of 156 persons were enrolled, with 78 assigned to each group. MDS-UPDRS part III scores at baseline were approximately 15 in both groups. At 12 months, scores on the MDS-UPDRS part III had changed by -0.04 points (indicating improvement) in the lixisenatide group and 3.04 points (indicating worsening disability) in the placebo group (difference, 3.08; 95% confidence interval, 0.86 to 5.30; P=0.007). At 14 months, after a 2-month washout period, the mean MDS-UPDRS motor scores in the off-medication state were 17.7 (95% CI, 15.7 to 19.7) with lixisenatide and 20.6 (95% CI, 18.5 to 22.8) with placebo. Other results relative to the secondary end points did not differ substantially between the groups. Nausea occurred in 46% of participants receiving lixisenatide, and vomiting occurred in 13%. CONCLUSIONS In participants with early Parkinson's disease, lixisenatide therapy resulted in less progression of motor disability than placebo at 12 months in a phase 2 trial but was associated with gastrointestinal side effects. Longer and larger trials are needed to determine the effects and safety of lixisenatide in persons with Parkinson's disease. (Funded by the French Ministry of Health and others; LIXIPARK ClinicalTrials.gov number, NCT03439943.) [ABSTRACT FROM AUTHOR]