Electric toothbrush application is a reliable and valid test for differentiating temporomandibular disorders pain patients from controls

<p>Abstract</p> <p>Background</p> <p>Current methods for identifying patients with pain hypersensitivity are sufficiently complex to limit their widespread application in clinical settings. We assessed the reliability and validity of a simple multi-modal vibrotactile stimulus, applied using an electric toothbrush, to evaluate its potential as a screening tool for central sensitization.</p> <p>Methods</p> <p>Fourteen female temporomandibular disorders (TMD) subjects with myofascial pain (RDC/TMD Ia or Ib) and arthralgia (RDC/TMD IIIa) were compared to 13 pain-free controls of matched age and gender. Vibrotactile stimulus was performed with an electric toothbrush, applied with 1 pound pressure for 30 seconds in four locations: over the lateral pole of the temporomandibular joint, masseter, temporalis, and mid-ventral surface of forearm. Pain intensity (0–10) was recorded following the stimulus at 0, 15, 30, and 60 seconds. Test-retest reliability was assessed with measurements from 8 participants, taken 2–12 hours apart. Case versus control differentiation involved comparison of area under the curve (AUC). A receiver operating characteristic (ROC) curve was used to determine cutoff AUC scores for maximum sensitivity and specificity for this multi-modal vibrotactile stimulus.</p> <p>Results</p> <p>Test-retest reliability resulted in an ICC of 0.87 for all 4 pooled sites. ROC-determined AUC cutoff scores resulted in a sensitivity of 57% and specificity of 92% for all 4 pooled sites.</p> <p>Conclusion</p> <p>The electric toothbrush stimulus had excellent test-retest reliability. Validity of the scores was demonstrated with modest sensitivity and good specificity for differentiating TMD pain patients from controls, which are acceptable properties for a screening test.</p

Emission pathways consistent with a 2 degree C global temperature limit

In recent years, international climate policy has increasingly focused on limiting temperature rise, as opposed to achieving greenhouse-gas-concentration-related objectives. The agreements reached at the United Nations Framework Convention on Climate Change conference in Cancun in 2010 recognize that countries should take urgent action to limit the increase in global average temperature to less than 2 degrees C relative to pre-industrial levels. If this is to be achieved, policymakers need robust information about the amounts of future greenhouse-gas emissions that are consistent with such temperature limits. This, in turn, requires an understanding of both the technical and economic implications of reducing emissions and the processes that link emissions to temperature. Here we consider both of these aspects by reanalysing a large set of published emission scenarios from integrated assessment models in a risk-based climate modelling framework. We find that in the set of scenarios with a "likely" (greater than 66%) chance of staying below 2 degrees C, emissions peak between 2010 and 2020 and fall to a median level of 44 Gt of CO2 equivalent in 2020 (compared with estimated median emissions across the scenario set of 48 Gt of CO2 equivalent in 2010). Our analysis confirms that if the mechanisms needed to enable an early peak in global emissions followed by steep reductions are not put in place, there is a significant risk that the 2 degree C target will not be achieved

Residential Eviction and Risk of Detectable Plasma HIV-1 RNA Viral Load Among HIV-Positive People Who Use Drugs

We examined the relationship between residential eviction and exhibiting detectable plasma HIV-1 RNA viral load (VL) among a prospective cohort of antiretroviral therapy (ART)-exposed HIV-seropositive people who use illicit drugs (PWUD) in Vancouver, Canada. We used multivariable generalized estimating equations to estimate the effect of residential eviction on detectable VL and examine ART adherence as a mediating variable. Between June 2007 and May 2014, 705 ART-exposed participants were included in the study, among whom 500 (70.9%) experienced at least one period of detectable VL. In a time-updated multivariable model, eviction independently increased the odds of detectable VL among those who were homeless (adjusted odds ratio [AOR] = 2.25; 95% confidence interval [CI]: 1.18 – 4.29) as well as not homeless (AOR = 1.76; 95% CI: 1.17 – 2.63) post eviction. The results of mediation analyses suggest that this association was mediated by incomplete ART adherence. These findings suggest the need for further development and evaluation of interventions to prevent evictions and promote ART adherence among PWUD facing eviction