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

Interprofessional learning in practice: The student experience

Interprofessional learning and the development of teamworking skills are recognised as essential for patient care and are also a government priority for undergraduate education. Sixteen occupational therapy students worked on an interprofessional training ward as part of their practice placement and three of them participated in an evaluation using the nominal group technique. Despite this small number, the evaluation identifies the value of this learning experience in giving the students an opportunity to appreciate the importance of interpersonal skills; to learn about other team members’ roles; and to experience the challenges of working on a busy rehabilitation ward for older people

Evaluating Land Management Options (ELMO): a participatory tool for assessing farmers’ sustainable land management decision preferences and trade-offs

This document provides guidance on applying the ELMO tool. It is primarily targeted at researchers seeking to collect information about the social and economic drivers of land use decisions, and wishing to investigate farmers’ sustainable land management preferences and trade-offs. As illustrated on the facing page, ELMO is organised around three basic questions, and entails 10 steps. Although these steps follow a logical, iterative process, it should be emphasised that the tool can be modified and adapted to the specific needs and context within which it is being applied. It is not always necessary to apply each and every step

A Guide for participatory mapping of ecosystem services in multiuse agricultural landscapes: How to conduct a rapid spatial assessment of ecosystem services

This guide presents a step-by-step approach in using a participatory mapping method with community members to rapidly identify and map ecosystem services and changes in their supply across multiuse agricultural landscapes. Nongovernmental organizations (NGOs), government agencies and researchers can use this approach to learn from communities about how they use and access natural resources. This activity uses a landscape approach to help land management practitioners understand the ways in which people depend on and access ecosystem services and how changes in their availability impact livelihoods across the landscape. The mapping exercise involves using free, high resolution satellite imagery from Google Earth Pro, which presents an aerial view of the community in fine detail. Participants from the community in question identify key features on the map, which help them to understand the extent of the area the map represents. They are then led through a discussion on their resources such as water, livestock, cultivated land and uncultivated land. Through the discussion participants identify: (1) where resources are located on the landscape and how they are used; (2) changes in the supply of resources and how these changes are impacting livelihoods; and (3) restrictions to access, conflicts over use and management of each resource in question. Mapping with different groups, such as men, women and youth can show which resources are most important to different groups as well as differences in access and perceptions of change. The mapping exercise is intended to take between two and a half and three hours: including introductory and concluding discussions can add on another two hours. This guide presents examples and tips from mapping exercises that tested this approach in Ghana, Kenya, Malawi and Tanzania. We outline how this mapping exercise could be used in research, development and planning. Additionally, this guide includes appendices that contain: (1) a detailed explanation of how to create maps for each activity; (2) a set of materials that have been developed to accompany the mapping exercise; (3) steps for digitizing the maps (4) case study examples; and (5) additional sources of information

The Effects of Acute Anaerobic Exercise on the Cardiovascular and Metabolic Response to the Cold Pressor Test in Healthy Adult Males

International Journal of Exercise Science 13(3): 1729-1740, 2020. Little is known about the physiological response to the cold pressor test (CPT) when in a clinically-induced state of autonomic nervous system (ANS) imbalance, despite its utility in various disease- and injury-states. To date, research in this area is limited to acute aerobic and isometric exercise, with a paucity of research investigating the effects of anaerobic exercise on the physiological response to the CPT. Therefore, the purpose of our study was to assess the effects of the Wingate anaerobic cycle test (WAT) on cardiovascular (CV) and metabolic recovery following the CPT in a group of healthy adult males. A pre-post intervention study was conducted, whereby 10 healthy adult males (age = 29 ± 4 years, height = 182 ± 7 cm, mass = 83 ± 9 kg) completed a baseline cold pressor test (CPT-only) and a follow-up cold pressor test preceded by a Wingate anaerobic exercise test (WAT+CPT). Recovery slopes for various CV and metabolic variables, including heart rate (HR), blood pressure (BP), and relative oxygen consumption (O2) were analyzed using single-subject analysis, with celeration line slopes calculated for all participants in the CPT-only and WAT+CPT testing sessions. Celeration line slopes were compared between testing sessions using paired t-tests. No differences were identified for recovery slopes for HR (p = .295), diastolic BP (p = .300), and relative O2 (p= .176) when comparing CPT-only and WAT+CPT testing sessions. Our results suggest that the CPT elicits a CV and metabolic response beyond that elicited solely by an acute bout of anaerobic exercise. As such, the CPT may be able to serve as a surrogate test for anaerobic exercise for individuals where high-intensity exercise may be contraindicated. Future research is warranted however, as the specific physiological mechanisms governing the observed responses have yet to be elucidated

Identification of Domains of the HPV11 E1 Protein Required for DNA Replication in Vitro

AbstractThe HPV E1 and E2 proteins along with cellular factors, are required for replication of the viral genome. In this study we show that in vitro synthesized HPV11 E1 can support DNA replication in a cell-free system and is able to cooperate with E2 to recruit the host polymerase α primase to the HPV origin in vitro. Deletion analysis revealed that the N-terminal 166 amino acids of E1, which encompass a nuclear localization signal and a cyclin E-binding motif, are dispensable for E1-dependent DNA replication and for recruitment of pol α primase to the origin in vitro. A shorter E1 protein lacking the N-terminal 190 amino acids supported cell-free DNA replication at less than 25% the efficiency of wild-type E1 and was active in the pol α primase recruitment assay. An even shorter E1 protein lacking a functional DNA-binding domain due to a truncation of the N-terminal 352 amino acids was inactive in both assays despite the fact that it retains the ability to associate with E2 or pol α primase in the absence of ori DNA. We provide additional functional evidence that E1 interacts with pol α primase through the p70 subunit of the complex by showing that p70 can be recruited to the HPV origin by E1 and E2 in vitro, that the domain of E1 (amino acids 353–649) that binds to pol α primase in vitro is the same as that needed for interaction with p70 in the yeast two-hybrid system, and that exogenously added p70 competes with the interaction between E1 and pol α primase and inhibits E1-dependent cell-free DNA replication. On the basis of these results and the observation that pol α primase competes with the interaction between E1 and E2 in solution, we propose that these three proteins assemble at the origin in a stepwise process during which E1, following its interaction with E2, must bind to DNA prior to interacting with pol α primase

The relationship between psychological distress and multiple tender points across the adult lifespan

Multiple tender points are common in the population and, in studies of mid-life adults, are strongly associated with high levels of psychological distress. Whether this relationship occurs in older adults is unclear. This cross-sectional study investigated whether high levels of psychological distress would be associated with a high tender point count and whether the relationship would be moderated by age. Three thousand three hundred and seventy-nine individuals were mailed a questionnaire which included the Hospital Anxiety and Depression (HAD) scale, the Pain Catastrophising Scale (PCS), the Brief Illness Perception Questionnaire (Brief IPQ), and the Pittsburgh Sleep Quality Index (PSQI). A random sample of approximately 10% of subjects who returned the questionnaire undertook a physical assessment, including a manual tender point count assessment.A total of 2385 (71%) subjects completed the questionnaire, of whom 798 (33%) were invited to take part in the physical assessment and 290 (12%) participated. Of the 290 participants the median age was 64 years (range 34-97) and 63% were female. The median HAD score was 9 (IQR 5-14) and the median number of tender points was 3 (range 0-7).Increasing HAD score was positively and significantly associated with tender point count, but this relationship was not moderated by age. In a final multivariable model, sex, HAD score and PSQI score were independent predictors of multiple tender points.Psychological distress was associated with multiple tender points independent of age. Psychological distress and trouble sleeping were important, potentially modifiable factors associated with the outcome