Chronic pain assessments in children and adolescents : a systematic literature review of the selection, administration, interpretation, and reporting of unidimensional pain intensity scales

Background. Advances in pain assessment approaches now indicate which measures should be used to capture chronic pain experiences in children and adolescents. However, there is little guidance on how these tools should best be administered and reported, such as which time frames to use or how pain scores are categorised as mild, moderate, or severe. Objective. To synthesise current evidence on unidimensional, single-item pain intensity scale selection, administration, interpretation, and reporting. Methods. Databases were searched (inception: 18 January 2016) for studies in which unidimensional pain intensity assessments were used with children and adolescents with chronic pain. Ten quality criteria were developed by modifying existing recommendations to evaluate the quality of administration of pain scales most commonly used with children. Results. Forty-six studies met the inclusion criteria. The highest score achieved was 7 out of a possible 10 (median: 5; IQR: 4–6). Usage of scales varied markedly in administrator/completer, highest anchors, number of successive assessments, and time referent periods used. Conclusions. Findings suggest these scales are selected, administered, and interpreted inconsistently, even in studies of the same type. Furthermore, methods of administration are rarely reported or justified making it impossible to compare findings across studies. This article concludes by recommending criteria for the future reporting of paediatric chronic pain assessments in studies

‘It's like the bad guy in a movie who just doesn't die’ : a qualitative exploration of young people's adaptation to eczema and implications for self‐care

Background Eczema is a common childhood inflammatory skin condition, affecting more than one in five children. A popular perception is that children ‘outgrow eczema’, although epidemiological studies have shown that, for many, eczema follows a lifelong episodic course. Objectives To explore the perceptions of young people about the nature of their eczema and how these perceptions relate to their self‐care and adapting to living with eczema. Methods This is a secondary inductive thematic analysis of interviews conducted for Healthtalk.org. In total 23 interviews with young people with eczema were included. Of the 23 participants, 17 were female and six male, ranging from 17 to 25 years old. Results Participants generally experienced eczema as an episodic long‐term condition and reported a mismatch between information received about eczema and their experiences. The experience of eczema as long term and episodic had implications for self‐care, challenging the process of identifying triggers of eczema flare‐ups and evaluating the success of treatment regimens. Participants’ experiences of eczema over time also had implications for adaptation and finding a balance between accepting eczema as long term and hoping it would go away. This linked to a gradual shift in treatment expectations from ‘cure’ to ‘control’ of eczema. Conclusions For young people who continue to experience eczema beyond childhood, a greater focus on self‐care for a long‐term condition may be helpful. Greater awareness of the impact of early messages around ‘growing out of’ eczema and provision of high‐quality information may help patients to manage expectations and support adaptation to treatment regimens

Iron homeostasis and oxidative stress in idiopathic pulmonary alveolar proteinosis: a case-control study

<p>Abstract</p> <p>Background</p> <p>Lung injury caused by both inhaled dusts and infectious agents depends on increased availability of iron and metal-catalyzed oxidative stress. Because inhaled particles, such as silica, and certain infections can cause secondary pulmonary alveolar proteinosis (PAP), we tested the hypothesis that idiopathic PAP is associated with an altered iron homeostasis in the human lung.</p> <p>Methods</p> <p>Healthy volunteers (n = 20) and patients with idiopathic PAP (n = 20) underwent bronchoalveolar lavage and measurements were made of total protein, iron, tranferrin, transferrin receptor, lactoferrin, and ferritin. Histochemical staining for iron and ferritin was done in the cell pellets from control subjects and PAP patients, and in lung specimens of patients without cardiopulmonary disease and with PAP. Lavage concentrations of urate, glutathione, and ascorbate were also measured as indices of oxidative stress.</p> <p>Results</p> <p>Lavage concentrations of iron, transferrin, transferrin receptor, lactoferrin, and ferritin were significantly elevated in PAP patients relative to healthy volunteers. The cells of PAP patients had accumulated significant iron and ferritin, as well as considerable amounts of extracellular ferritin. Immunohistochemistry for ferritin in lung tissue revealed comparable amounts of this metal-storage protein in the lower respiratory tract of PAP patients both intracellularly and extracellularly. Lavage concentrations of ascorbate, glutathione, and urate were significantly lower in the lavage fluid of the PAP patients.</p> <p>Conclusion</p> <p>Iron homeostasis is altered in the lungs of patients with idiopathic PAP, as large amounts of catalytically-active iron and low molecular weight anti-oxidant depletion are present. These findings suggest a metal-catalyzed oxidative stress in the maintenance of this disease.</p

Energy Efficient Smartphone-Based Activity Recognition Using Fixed-Point Arithmetic

In this paper we propose a novel energy efficient approach for the recog- nition of human activities using smartphones as wearable sensing devices, targeting assisted living applications such as remote patient activity monitoring for the disabled and the elderly. The method exploits fixed-point arithmetic to propose a modified multiclass Support Vector Machine (SVM) learning algorithm, allowing to better pre- serve the smartphone battery lifetime with respect to the conventional floating-point based formulation while maintaining comparable system accuracy levels. Experiments show comparative results between this approach and the traditional SVM in terms of recognition performance and battery consumption, highlighting the advantages of the proposed method

Experimental and numerical analysis of supersonic blade profiles developed for highly loaded impulse type steam turbine stages

The paper describes the results of a numerical and experimental research program addressing the aerodynamic investigation on the performance of blade profiles specifically developed for application in highly loaded impulse type turbine stages. The industrial requirements driving toward the adoption of highly loaded stage solutions are presented, along with an estimation of the profiles operating parameters. Two stator vanes and one rotor blade profile have been developed and extensively tested by means of flow field measurements and schlieren visualization in a transonic blow-down wind tunnel for linear cascades. Experimental results for the relevant operating conditions are presented, providing validation data for the CFD model used for blade design and evidencing that the main goals of the design optimization procedure have been achieved

The GRAAL high resolution BGO calorimeter and its energy calibration and monitoring system

We describe the electromagnetic calorimeter built for the GRAAL apparatus at the ESRF. Its monitoring system is presented in detail. Results from tests and the performance obtained during the first GRAAL experiments are given. The energy calibration accuracy and stability reached is a small fraction of the intrinsic detector resolution.Comment: 19 pages, 14 figures, submitted to Nuclear Instruments and Method

Evidence for Narrow N*(1685) Resonance in Quasifree Compton Scattering on the Neutron

The first study of quasi-free Compton scattering on the neutron in the energy range of $E_{\gamma}=0.75 - 1.5$ GeV is presented. The data reveals a narrow peak at $W\sim 1.685$ GeV. This result, being considered in conjunction with the recent evidence for a narrow structure at $W\sim 1.68$GeV in the $\eta$ photoproduction on the neutron, suggests the existence of a new nucleon resonance with unusual properties: the mass $M\sim 1.685$GeV, the narrow width $\Gamma \leq 30$MeV, and the much stronger photoexcitation on the neutron than on the proton.Comment: Replaced with the version published in Phys. Rev.