Search

Diverse behavioral cues have been proposed to be useful cues in infant pain assessment, but there is a paucity of evidence on the basis of formal psychometric evaluation to establish their validity for this purpose. We aimed to examine 2 widely used coding systems, the Neonatal Facial Coding System (NFCS) and the Modified Behavior Pain Scale (MBPS), by examining their factor structures with confirmatory factor analysis using a large archival data set. The results indicated that an item-reduced NFCS scale with 3 items produced a 1-factor pain model that maintained the good psychometric properties of the 7-item scale. In addition, it was found that MBPS also has challenging internal consistency, with items that are weakly correlated as well as highly redundant. One item of the MBPS may be able to capture the construct of pain equally well or potentially improve its psychometric properties. Redefinition of the MBPS with cry as a sole indicator was suggested. This analysis provides 2 new iterations of the NFCS and MBPS that improve construct validity and internal consistency. These shorter versions also improve the feasibility of both measures and increase their potential for clinical use because less time is required for their administration.Perspective: This article presents new iterations of the NFCS and MBPS scales. These revised measures improve the internal consistency of the measures, feasibility of use of the tools in research settings, and the efficiency of the coding process. The revised tools could also improve the feasibility of coding within clinical settings. [ABSTRACT FROM AUTHOR]

Mononuclear invasion of Langerhans islet and the ensuing insulitis triggers signal-transduction for the autoimmune mediated pancreatic beta-cell (β-cell) apoptosis that severely disrupts insulin production resulting in hyperglycemia associated with Type-1 diabetes (T1DM). Today extensive global research is being conducted to eliminate the need for insulin, and even prevent or find a cure for T1DM. The multifactorial combination of autoimmune dysfunction, Langerhans islet hypoxia, and bio-chemical disruption are seen to be contributory factors for β-cell destruction and the consequential disruption to insulin production. Regeneration of β-cells back to physiological levels may restore homeostatic insulin levels, reversing T1DM. Evidence suggests that there are still functioning pancreatic β-cells even in long standing T1DM providing the potential for their regeneration. Although the exact mechanism of extracorporeal shockwaves (ESW) is yet to be fully elucidated, it is seen to influence a complex spectrum of bio-chemical, cellular and neuronal functions (i.e. suppression of pro-inflammatory immune response, improved tissue hemodynamics, anti-microbial properties, and the induction of progenitor cell expression including proangiogenic factors and nitric oxide syntheses). The rationale for the use of ESW as a therapeutic modality in this instance is attributed to its restorative properties and safety profile demonstrated in urology, cardiology, chronic wounds, osteogenesis, complex pain syndromes, and tendinopathies. ESW may restore autoimmune homeostasis creating a suitable environment for pancreatic β-cell proliferation which in-turn may significantly increase or normalize endogenous insulin secretion reducing or totally eliminating dependency of exogenous insulin. The devastating complications, morbidity and mortality associated with T1DM warrants the exploration of homeostatic autoimmune restorative treatment (HART) modalities that may partially or fully reverse this disease condition. We present our hypothesis discussing ESW as a potential homeostatic autoimmune restorative treatment (HART) option for T1DM. [ABSTRACT FROM AUTHOR]

Abstract: This study examined the impact of evidence concerning the presence of 1) a biomedical basis for pain and 2) psychosocial influences on practitioner appraisals of patient pain experiences. Furthermore, the potential moderating role of patient pain behavior was examined. In an online study, 52 general practitioners and 46 physiotherapists viewed video sequences of 4 patients manifesting pain, with accompanying vignettes describing presence or absence of medical evidence and psychosocial influences. Participants estimated pain intensity, daily interference, sympathy felt, effectiveness of pain medication, self-efficacy, their likability, and suspicions of deception. Primary findings indicated lower perceived pain and daily interference, less sympathy, lower expectations of medication impact, and less self-efficacy when medical evidence was absent. The same results were found when psychosocial influences were present, but only when the patient displayed higher levels of pain behavior. Furthermore, absence of medical evidence was related to less positive evaluations of the patients and to higher beliefs in deception in both professions. The presence of psychosocial influences was related to less positive evaluations and higher beliefs in deception in both professions. In sum, a range of contextual factors influence health care practitioner responses to patient pain. Implications for caregiving behavior are discussed. Perspective: The present study indicates that in the absence of clear medical evidence and in the presence of psychosocial influences, patient pain might be taken less seriously by health care practitioners. These findings are important to further understand the difficulties that relate to the clinical encounter between pain patients and health care practitioners. [Copyright &y& Elsevier]

Abstract: Although direct experience and verbal instruction are important sources in the development of pain-related beliefs and behaviors, accumulating evidence indicates that observation of others in pain may be equally as important. Taking a contemporary view on learning as a starting point, we discuss available evidence on observational learning in the context of pain, highlight its importance for both development and management of chronic pain problems, and discuss potential moderators of observational learning effects. We argue that the capacity to understand and appreciate the experience of another person is fundamental to observational learning, including use of this information to establish the association between pain and antecedent or consequent stimuli. A main objective of this paper is to stimulate research on the role of learning about pain from others. Several lines for further research, including clinical applications, are delineated. Perspective: Based upon a contemporary view on learning, this focus article delineates how pain-related beliefs and behaviors may be learnt by observing others. It is discussed how further research on the acquisition of pain-related beliefs/behaviors might further our understanding of pain and disability. [Copyright &y& Elsevier]

Abstract: Recent developments in clinical, cognitive, and behavioral sciences as well as in social neuroscience can provide new perspectives on our understanding of different forms of pain expression and the social reactions of observers to various types of pain expression. Studies indicate that pain expression is governed by both automatic (unintentional, reflexive) and controlled (intentional, purposive) neuroregulatory systems. Reciprocal mechanisms in observers responsible for automatic (unintentional, reflexive) and controlled (intentional, reflective) reactions also are important. Observers appear more likely to display immediate “visceral” emotional reactions to unintentional, reflexive expression, whereas controlled expression characterized by purposive behavior appears more likely to elicit reflection on the nature and origins of the person''s pain. This review summarizes research within the context of a theoretical model for understanding how pain is perceived in others. Perspective: People attempting to understand another person''s pain may have access to the person''s spontaneous behavioral reaction as well as verbal report and other purposive communications. The former instigates reflexive and emotional reactions, whereas the latter tends to be perceived as confounding expression of experience with response to situational demands. [Copyright &y& Elsevier]

Presents the findings of a study on the implications of the cognitive-behavioral responses of health anxious individuals to health related information. Methodology of the study; Analyses of results; Clinical implications and future research directions.

Modeling analyses were developed to evaluate near-road PM 2.5 concentrations predicted by the AERMOD dispersion modeling chain under real-world conditions, and to assess the sensitivity of modeled near-road concentrations to the choice of dispersion model (AERMOD or CAL3QHCR), meteorological data, and travel data processing approach. We evaluate PM 2.5 monitoring sites near major freeways in Indianapolis, Indiana (for 2016) and Providence, Rhode Island (for 2015–2016). The modeling analyses are built upon bottom-up estimates of temporally and spatially resolved roadway PM 2.5 emissions based on traffic monitoring data and local vehicle fleet emission factors. The dispersion model simulations use local meteorological data collected at or close to the near-road monitoring sites. Predictions involved a modeling chain that included travel activity data processing, emissions modeling (MOVES and AP-42), and air quality dispersion modeling. We estimated the difference between PM 2.5 concentrations at the near-road monitor and at nearby urban air quality monitoring sites (the measured near-road "increment"), and compared modeled results to the measured increments. Based on monitoring data, estimates of multi-day-averaged near-road PM 2.5 increments were 0.9 ± 0.6 μg/m3 at Indianapolis and 1.4 ± 0.2 μg/m3 at Providence (where the uncertainty represents the 95% confidence interval on the mean value), and were comparable to measured PM 2.5 increments at these sites in the near-road literature. Modeled roadway contributions to multi-day-averaged near-road concentrations substantially exceeded measured values based on the near-road monitoring data. The average near-road PM 2.5 increment modeled with AERMOD was more than 300% (factor of four) larger than the measured increment at Indianapolis, and more than 500% (factor of six) larger than the measured increment at Providence. These biases reflect cumulative uncertainty throughout the near-road PM 2.5 modeling chain. The emissions modeling component may have contributed to the modeling chain biases in two ways. First, the relative contribution of modeled non-exhaust emissions (PM 2.5 brake wear, tire wear, and re-suspended road dust) compared to tailpipe exhaust emissions was higher than what has been documented in several published studies. Second, other research findings indicate that the U.S. EPA MOVES2014 model may over-predict tailpipe PM 2.5 exhaust. The dispersion modeling component may have also contributed to the modeling chain biases. For example, when local meteorological data were used, AERMOD results were relatively insensitive to wind direction on a daily averaged basis; as a result, modeled concentrations exceeded measured values regardless of whether the near-road monitor was upwind or downwind of the roadway. In summary, this work provides a unique evaluation of PM 2.5 concentrations predicted by the near-road modeling chain, and provides valuable information to understand potential sources of uncertainty in the near-road modeling process. • Modeled near-road PM2.5 increments substantially exceeded measured values. • Road dust PM2.5 was the biggest source of modeled roadway emissions. • Relative contribution of modeled non-exhaust emissions was high compared to published studies. • Uncertainty was likely dominated by dispersion and emission modeling components. [ABSTRACT FROM AUTHOR]

Summary Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently under-recognised, underestimated, and undertreated. Results from neurophysiological and neuroimaging studies showing that elderly adults are particularly susceptible to the negative effects of pain are of additional concern. The inability to successfully communicate pain in severe dementia is a major barrier to effective treatment. The systematic study of facial expressions through a computerised system has identified core features that are highly specific to the experience of pain, with potential future effects on assessment practices in people with dementia. Various observational–behavioural pain assessment instruments have been reported to be both reliable and valid in individuals with dementia. These techniques need to be interpreted in the context of observer bias, contextual variables, and the overall state of the individual's health and wellbeing. [ABSTRACT FROM AUTHOR]