Clinical presentations on a facial pain clinic

Introduction: The complex nature of facial pain conditions creates a diagnostic challenge which may necessitate specialist referral. Aim: To identify the case mix presenting to a specialist tertiary care facial pain clinic. Methods: A retrospective review of 112 patient records was undertaken. Trends in provisional diagnoses from referrers and the correlation to diagnoses made following specialist consultation were reviewed. Results: The most common provisional diagnoses recorded in referral letters were painful temporomandibular disorders, trigeminal neuralgia and persistent idiopathic facial pain (PIFP). Over a quarter of referrals did not include a provisional diagnosis. Following assessment, only one case was not given a definitive diagnosis and no patients were diagnosed with PIFP. A causative factor was identified in all the initially queried PIFP cases, and painful post-traumatic trigeminal neuropathic pain was found in multiple patients. Conclusions: Painful post-traumatic trigeminal neuropathic pain should be considered if pain onset coincides with dental treatment or other traumatic events. PIFP is a rare facial pain diagnosis and may be over-diagnosed by dental and medical practitioners. It is important to systematically exclude other causes before reaching this diagnosis. This will facilitate effective treatment, manage patient expectations and potentially reduce unnecessary referrals

Web-Based Skin Cancer Prevention Training for Massage Therapists: Protocol for the Massage Therapists Skin Health Awareness, Referral, and Education Study

Background: Skin cancer, the most common cancer in the United States, is costly and potentially deadly. Its burden can be reduced by early detection and prevention activities. The scope of skin cancer requires going beyond traditional health care providers to promote risk reduction. Partnering with the nonbiomedical workforce, such as massage therapists (MTs), may reach more individuals at risk. MTs see much of their clients' skin and are amenable to performing skin cancer risk reduction activities during massage appointments. Objective: The objective of this study is to describe the Massage Therapists Skin Health Awareness, Referral, and Education protocol, presenting an overview of our systematic approach to developing rigorous e-training for MTs to enable them to be partners in skin cancer risk reduction. We also describe procedures for usability and feasibility testing of the training. Methods: We developed an integrated electronic learning system that includes electronic training (e-training) technology, simulated client interactions, online data collection instruments, and in-person assessment of MTs' application of their training. Results: A total of 20 participants nationally scored the e-training as high for usability and satisfaction. We have screened an additional 77 MTs in Arizona for interest and eligibility, and currently have 37 enrolled participants, of whom 32 have completed the Web-based training. Conclusions: The structured and rigorous development approach for this skin cancer risk reduction and brief behavioral intervention e-training for MTs begins to fill a gap in skin cancer risk reduction research. Iterative usability testing of our asynchronous Web-based training resulted in positive participant response. Our e-training approach offers greater learner accessibility, increased convenience, and greater scalability than the few existing programs and has the potential to reach many MTs nationally.Arizona Biomedical Research Centre through the Arizona Department of Health Services [ABRC/ADHS16-162518]; National Institutes of Health-National Cancer Institute (NIH-NCI) Cancer Center Support Grant [P30 CA023074]open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Parental and child-level predictors of HIV testing uptake, seropositivity and treatment initiation among children and adolescents in Cameroon

Background: There is a growing body of evidence positioning targeted provider-initiated testing and counselling (tPITC, also known as index case testing) as a promising HIV case-finding and linkage strategy among children and adolescents. However, the effectiveness and efficiency of this strategy is limited by low HIV testing uptake and case detection rates. Despite this fact, there is very little literature on factors associated with HIV testing uptake, HIV seropositivity and ART-enrolment in tPITC implementation among African children. This study aims to bridge this information gap and contribute in improving the effectiveness and efficiency of tPITC among children and adolescents in Cameroon and beyond. Methods In three ART clinics where tPITC was previously inexistent, we introduced the routine implementation of this strategy by inviting parents living with HIV/AIDS in care to have their biological children (6 weeks-19 years) HIV-tested. Children of consenting parents were HIV-tested;those testing positive were enrolled on ART. Parental and child-level characteristics associated with HIV testing uptake, seropositivity and ART-enrollment were assessed using bivariate and multivariate regression analysis at 5% significance level. Results We enrolled 1,236 parents, through whom 1,990 children/adolescents were recruited for HIV testing. Among enrolled parents, 46.2% (571/1,236) had at least one child tested, and 6.8% (39/571) of these parents had at least one HIV-positive child. Among enrolled children/adolescents, 56.7% (1,129/1,990) tested for HIV and 3.5% (40/1129) tested HIV-positive. Parental predictors of HIV testing uptake among children/adolescents were sex, occupation and duration on ART: female [aOR = 1.6 (1.1-2.5)], office workers/students [aOR = 2.0 (1.2-3.3)], and parents with ART duration > 5 years [aOR = 2.0 (1.3-2.9)] had significantly higher odds to test a child than male, farmers/traders, and parents with ART duration 15 years. Parents of children identified as HIV-positive were more likely to be female, aged 40-60 years, farmers/traders, widows/divorcees and not on ART. Children found HIV-positive and who were ART-enrolled were more likely to be female and aged 5-9 years. However, none of the above-mentioned associations was statistically significant. Conclusions: Parents who were male, farmers/traders, and on ART for. 5 years were less likely to test their children for HIV. Also, adolescents 10-19 years old were less likely to be tested. Therefore, these groups should be targeted with intensive counseling and follow-up to facilitate optimal testing uptake. No association was found between parental or child-level characteristics and HIV seropositivity among tested children. This finding prompts for further research to investigate approaches to better identify and target HIV testing to children/adolescents with the highest likelihood of HIV seropositivity

Correlation of Nav1.8 and Nav1.9 sodium channel expression with neuropathic pain in human subjects with lingual nerve neuromas

Background: Voltage-gated sodium channels Nav1.8 and Nav1.9 are expressed preferentially in small diameter sensory neurons, and are thought to play a role in the generation of ectopic activity in neuronal cell bodies and/or their axons following peripheral nerve injury. The expression of Nav1.8 and Nav1.9 has been quantified in human lingual nerves that have been previously injured inadvertently during lower third molar removal, and any correlation between the expression of these ion channels and the presence or absence of dysaesthesia investigated. Results: Immunohistochemical processing and quantitative image analysis revealed that Nav1.8 and Nav1.9 were expressed in human lingual nerve neuromas from patients with or without symptoms of dysaesthesia. The level of Nav1.8 expression was significantly higher in patients reporting pain compared with no pain, and a significant positive correlation was observed between levels of Nav1.8 expression and VAS scores for the symptom of tingling. No significant differences were recorded in the level of expression of Nav1.9 between patients with or without pain. Conclusions: These results demonstrate that Nav1.8 and Nav1.9 are present in human lingual nerve neuromas, with significant correlations between the level of expression of Nav1.8 and symptoms of pain. These data provide further evidence that changes in expression of Nav1.8 are important in the development and/or maintenance of nerve injury-induced pain, and suggest that Nav1.8 may be a potential therapeutic target

Seasonal evolution of Aleutian low pressure systems: Implications for the North Pacific subpolar circulation

The seasonal change in the development of Aleutian low pressure systems from early fall to early winter is analyzed using a combination of meteorological reanalysis fields, satellite sea surface temperature (SST) data, and satellite wind data. The time period of the study is September–December 2002, although results are shown to be representative of the long-term climatology. Characteristics of the storms were documented as they progressed across the North Pacific, including their path, central pressure, deepening rate, and speed of translation. Clear patterns emerged. Storms tended to deepen in two distinct geographical locations—the Gulf of Alaska in early fall and the western North Pacific in late fall. In the Gulf of Alaska, a quasi-permanent “notch” in the SST distribution is argued to be of significance. The signature of the notch is imprinted in the atmosphere, resulting in a region of enhanced cyclonic potential vorticity in the lower troposphere that is conducive for storm development. Later in the season, as winter approaches and the Sea of Okhotsk becomes partially ice covered and cold, the air emanating from the Asian continent leads to enhanced baroclinicity in the region south of Kamchatka. This corresponds to enhanced storm cyclogenesis in that region. Consequently, there is a seasonal westward migration of the dominant lobe of the Aleutian low. The impact of the wind stress curl pattern resulting from these two regions of storm development on the oceanic circulation is investigated using historical hydrography. It is argued that the seasonal bimodal input of cyclonic vorticity from the wind may be partly responsible for the two distinct North Pacific subarctic gyres

Retrieval and Validation of Carbon Dioxide, Methane, and Water Vapor for the Canary Islands IR-Laser Occultation Experiment

The first ground-based experiment to prove the concept of a novel space-based observation technique for microwave and infrared-laser occultation between low-Earthorbit satellites was performed in the Canary Islands between La Palma and Tenerife. For two nights from 21 to 22 July 2011 the experiment delivered the infrared-laser differential transmission principle for the measurement of greenhouse gases (GHGs) in the free atmosphere. Such global and long-term stable measurements of GHGs, accompanied also by measurements of thermodynamic parameters and line-of-sight wind in a self-calibrating way, have become very important for climate change monitoring. The experiment delivered promising initial data for demonstrating the new observation concept by retrieving volume mixing ratios of GHGs along a ~ 144 km signal path at altitudes of ~ 2.4 km. Here, we present a detailed analysis of the measurements, following a recent publication that introduced the experiment\u27s technical setup and first results for an example retrieval of CO2. We present the observational and validation data sets, the latter simultaneously measured at the transmitter and receiver sites; the measurement data handling; and the differential transmission retrieval procedure. We also determine the individual and combined uncertainties influencing the results and present the retrieval results for 12CO2, 13CO2, C18OO, H2O and CH4. The new method is found to have a reliable basis for monitoring of greenhouse gases such as CO2, CH4, and H2O in the free atmosphere

Amplification and dampening of soil respiration by changes in temperature variability

Accelerated release of carbon from soils is one of the most important feedbacks related to anthropogenically induced climate change. Studies addressing the mechanisms for soil carbon release through organic matter decomposition have focused on the effect of changes in the average temperature, with little attention to changes in temperature variability. Anthropogenic activities are likely to modify both the average state and the variability of the climatic system; therefore, the effects of future warming on decomposition should not only focus on trends in the average temperature, but also variability expressed as a change of the probability distribution of temperature. Using analytical and numerical analyses we tested common relationships between temperature and respiration and found that the variability of temperature plays an important role determining respiration rates of soil organic matter. Changes in temperature variability, without changes in the average temperature, can affect the amount of carbon released through respiration over the longterm. Furthermore, simultaneous changes in the average and variance of temperature can either amplify or dampen the release of carbon through soil respiration as climate regimes change. These effects depend on the degree of convexity of the relationship between temperature and respiration and the magnitude of the change in temperature variance. A potential consequence of this effect of variability would be higher respiration in regions where both the mean and variance of temperature are expected to increase, such as in some low latitude regions; and lower amounts of respiration where the average temperature is expected to increase and the variance to decrease, such as in northern high latitudes

Building a Global Ecosystem Research Infrastructure to Address Global Grand Challenges for Macrosystem Ecology

The development of several large-, "continental"-scale ecosystem research infrastructures over recent decades has provided a unique opportunity in the history of ecological science. The Global Ecosystem Research Infrastructure (GERI) is an integrated network of analogous, but independent, site-based ecosystem research infrastructures (ERI) dedicated to better understand the function and change of indicator ecosystems across global biomes. Bringing together these ERIs, harmonizing their respective data and reducing uncertainties enables broader cross-continental ecological research. It will also enhance the research community capabilities to address current and anticipate future global scale ecological challenges. Moreover, increasing the international capabilities of these ERIs goes beyond their original design intent, and is an unexpected added value of these large national investments. Here, we identify specific global grand challenge areas and research trends to advance the ecological frontiers across continents that can be addressed through the federation of these cross-continental-scale ERIs.Peer reviewe