Do photographic images of pain improve communication during pain consultations?

BACKGROUND: Visual images may facilitate the communication of pain during consultations. OBJECTIVES: To assess whether photographic images of pain enrich the content and⁄or process of pain consultation by comparing patients' and clinicians' ratings of the consultation experience. METHODS: Photographic images of pain previously co-created by patients with a photographer were provided to new patients attending pain clinic consultations. Seventeen patients selected and used images that best expressed their pain and were compared with 21 patients who were not shown images. Ten clinicians conducted assessments in each condition. After consultation, patients and clinicians completed ratings of aspects of communication and, when images were used, how they influenced the consultation. RESULTS: The majority of both patients and clinicians reported that images enhanced the consultation. Ratings of communication were generally high, with no differences between those with and without images (with the exception of confidence in treatment plan, which was rated more highly in the image group). However, patients' and clinicians' ratings of communication were inversely related only in consultations with images. Methodological shortcomings may underlie the present findings of no difference. It is also possible that using images raised patients' and clinicians' expectations and encouraged emotional disclosure, in response to which clinicians were dissatisfied with their performance. CONCLUSIONS: Using images in clinical encounters did not have a negative impact on the consultation, nor did it improve communication or satisfaction. These findings will inform future analysis of behaviour in the video-recorded consultations

UV Spectra and Excitation Delocalization in DNA: Influence of the Spectral Width

The singlet excited states of the model DNA duplex (dA)10.(dT)10 are studied. Calculations are performed in the exciton theory framework. Molecular dynamics calculations provide the duplex geometry. The dipolar coupling is determined using atomic transition charges. The monomer transition energies are simulated by Gaussian functions resembling the absorption bands of nucleosides in aqueous solutions. Most of the excited states are found to be delocalized over at least two bases and result from the mixing of different monomer states. Their properties are only weakly affected by conformational changes of the double helix. On average, the highest oscillator strength is carried by the upper eigenstates. The duplex absorption spectra are shifted a few nanometers to higher energies with respect to the spectra of noninteracting monomers. The states with larger spatial extent are located close to the maximum of the absorption spectrum

Images as catalysts for meaning-making in medical pain encounters: a multidisciplinary analysis

The challenge for those treating or witnessing pain is to find a way of crossing the chasm of meaning between them and the person living with pain. This paper proposes that images can strengthen agency in the person with pain, particularly but not only in the clinical setting, and can create a shared space within which to negotiate meaning. It draws on multidisciplinary analyses of unique material resulting from two fine art/medical collaborations in London, UK, in which the invisible experience of pain was made visible in the form of co-created photographic images, which were then made available to other patients as a resource to use in specialist consultations. In parallel with the pain encounters it describes, the paper weaves together the insights of specialists from a range of disciplines whose methodologies and priorities sometimes conflict and sometimes intersect to make sense of each other’s findings. A short section of video footage where images were used in a pain consultation is examined in fine detail from the perspective of each discipline. The analysis shows how the images function as ‘transactional objects’ and how their use coincides with an increase in the amount of talk and emotional disclosure on the part of the patient and greater non-verbal affiliative behaviour on the part of the doctor. These findings are interpreted from the different disciplinary perspectives, to build a complex picture of the multifaceted, contradictory and paradoxical nature of pain experience, the drive to communicate it and the potential role of visual images in clinical settings

Exciton States of Dynamic DNA Double Helices: Alternating dCdG Sequences

The present communication deals with the excited states of the alternating DNA oligomer (dCdG)5·(dCdG)5 which correspond to the UV absorption band around 260 nm. Their properties are studied in the frame of the exciton theory, combining molecular dynamics simulations and quantum chemistry data. It is shown that the dipolar coupling undergoes important variations with the site and the helix geometry. In contrast, the energy of the monomer transitions within the double helix is not sensitive to the local environment. It is thus considered to be distributed over Gaussian curves whose maximum and width are derived from the experimental absorption spectra of nucleosides in aqueous solution. The influence of the spectral width on the excited state delocalization and the absorption spectra is much stronger than that of the oligomer plasticity. About half of the excited states are delocalized over at least two bases. Many of them result from the mixing of different monomer states and extend on both strands. The trends found in the simulated spectra, when going from non-interacting monomers to the duplex, are in agreement with experimental observations. Conformational changes enhance the diversity of the states which can be populated upon excitation at a given energy. The states with larger spatial extent are located close to the maximum of the absorption spectrum

A Fast and Efficient Incremental Approach toward Dynamic Community Detection

Community detection is a discovery tool used by network scientists to analyze the structure of real-world networks. It seeks to identify natural divisions that may exist in the input networks that partition the vertices into coherent modules (or communities). While this problem space is rich with efficient algorithms and software, most of this literature caters to the static use-case where the underlying network does not change. However, many emerging real-world use-cases give rise to a need to incorporate dynamic graphs as inputs. In this paper, we present a fast and efficient incremental approach toward dynamic community detection. The key contribution is a generic technique called $\Delta-screening$, which examines the most recent batch of changes made to an input graph and selects a subset of vertices to reevaluate for potential community (re)assignment. This technique can be incorporated into any of the community detection methods that use modularity as its objective function for clustering. For demonstration purposes, we incorporated the technique into two well-known community detection tools. Our experiments demonstrate that our new incremental approach is able to generate performance speedups without compromising on the output quality (despite its heuristic nature). For instance, on a real-world network with 63M temporal edges (over 12 time steps), our approach was able to complete in 1056 seconds, yielding a 3x speedup over a baseline implementation. In addition to demonstrating the performance benefits, we also show how to use our approach to delineate appropriate intervals of temporal resolutions at which to analyze an input network

Visualization of amphetamine and its analogues in TLC

Derivatisation followed by iodine azide reaction was employed for detection of amphetamines and its analogues in TLC. The derivatisation reaction with phenyl isothiocyanate took place directly on the TLC plate before the developing step. Afterwards, the plate was sprayed with a mixture of sodium azide and starch solution and then exposed to iodine vapour. The obtained limits of detection were compared with other commonly visualization techniques: UV, iodine vapour, Marquis and Simon’s reagents, ninhydrin, Fast Black K

Conformational analysis of nucleic acids revisited: Curves+

We describe Curves+, a new nucleic acid conformational analysis program which is applicable to a wide range of nucleic acid structures, including those with up to four strands and with either canonical or modified bases and backbones. The program is algorithmically simpler and computationally much faster than the earlier Curves approach, although it still provides both helical and backbone parameters, including a curvilinear axis and parameters relating the position of the bases to this axis. It additionally provides a full analysis of groove widths and depths. Curves+ can also be used to analyse molecular dynamics trajectories. With the help of the accompanying program Canal, it is possible to produce a variety of graphical output including parameter variations along a given structure and time series or histograms of parameter variations during dynamic

Optical Properties of Guanine Nanowires: Experimental and Theoretical Study

International audienceLong nanowires formed by ca. 800 guanine tetrads (G4-wires) are studied in phosphate buffer containing sodium cations. Their room temperature optical properties are compared to those of the monomeric chromophore 2-deoxyguanine monophosphate (dGMP). When going from dGMP to G4-wires, both the absorption and the fluorescence spectra change. Moreover, the fluorescence quantum yield increases by a factor of 7.3 whereas the average fluorescence lifetime increases by more than 2 orders of magnitude, indicating emission associated with weakly allowed transitions. The behavior of G4-wires is interpreted in the light of a theoretical study performed in the frame of the exciton theory combining data from molecular dynamics and quantum chemistry. These calculations, carried out for a quadruplex composed of three tetrads, reveal the existence of various exciton states having different energies and oscillator strengths. The degree of delocalization of the quadruplex Franck−Condon excited states is larger than those found for longer duplexes following the same methodology. The slower excited-state relaxation in G4-wires compared to dGMP is explained by emission from exciton states, possibly limited on individual tetrads, whose coherence is reserved by the reduced mobility of guanines due to multiple Hoogsteen hydrogen bonds

Comparison of tolerability and adverse symptoms in oxcarbazepine and carbamazepine in the treatment of trigeminal neuralgia and neuralgiform headaches using the Liverpool Adverse Events Profile (AEP)

Background Adverse effects of drugs are poorly reported in the literature . The aim of this study was to examine the frequency of the adverse events of antiepileptic drugs (AEDs), in particular carbamazepine (CBZ) and oxcarbazepine (OXC) in patients with neuralgiform pain using the psychometrically tested Liverpool Adverse Events Profile (AEP) and provide clinicians with guidance as to when to change management. Methods The study was conducted as a clinical prospective observational exploratory survey of 161 patients with idiopathic trigeminal neuralgia and its variants of whom 79 were on montherapy who attended a specialist clinic in a London teaching hospital over a period of 2 years. At each consultation they completed the AEP questionnaire which provides scores of 19–76 with toxic levels being considered as scores >45. Results The most common significant side effects were: tiredness 31.3 %, sleepiness 18.2 %, memory problems 22.7 %, disturbed sleep 14.1 %, difficulty concentrating and unsteadiness 11.6 %. Females reported significantly more side effects than males. Potential toxic dose for females is approximately 1200 mg of OXC and 800 mg of CBZ and1800mg of OXC and 1200 mg of CBZ for males. Conclusions CBZ and OXC are associated with cognitive impairment. Pharmacokinetic and pharmacodynamic differences are likely to be the reason for gender differences in reporting side effects. Potentially, females need to be prescribed lower dosages in view of their tendency to reach toxic levels at lower dosages. Side effects associated with AED could be a major reason for changing drugs or to consider a referral for surgical management

Do photographic images of pain improve communication in the pain consultation?

Background: Visual images may facilitate communication of pain in consultations. Objectives: In order to test whether photographic images of pain enrich the content and/or process of pain consultation, we compared patients’ and clinicians’ ratings of the consultation experience. Methods Photographic images of pain previously co-created by patients with a photographer were provided to new patients attending pain clinic consultations. Seventeen patients selected and used images that best expressed their pain and were compared with 21 not offered images. Ten clinicians conducted assessments in each condition. After consultation patients and clinicians completed ratings of aspects of communication and, where images were used, how they influenced the consultation. Results: The majority of both patients and clinicians reported that images enhanced the consultation. Ratings of communication were generally high, with no differences between those with and without images (except for confidence in treatment plan which was rated more highly in the image group). However, only in consultations with images, patients’ and clinicians’ ratings of communication were inversely related. Methodological shortcomings may underlie our findings of no difference. It is also possible that using images raised patients’ and clinicians’ expectations and encouraged emotional disclosure in response to which clinicians were dissatisfied with their performance. Conclusions: Using images in clinical encounters does not have negative impacts on the consultation but did not improve communication or satisfaction. Findings will inform analysis of behaviour in the video-recorded consultations