British pain clinic practitioners' recognition and use of the bio-psychosocial pain management model for patients when physical interventions are ineffective or inappropriate : results of a qualitative study

Background To explore how chronic musculoskeletal pain is managed in multidisciplinary pain clinics for patients for whom physical interventions are inappropriate or ineffective. Methods A qualitative study was undertaken using semi-structured interviews with twenty five members of the pain management team drawn from seven pain clinics and one pain management unit located across the UK. Results All clinics reported using a multidisciplinary bio-psychosocial model. However the chronic pain management strategy actually focussed on psychological approaches in preference to physical approaches. These approaches were utilised by all practitioners irrespective of their discipline. Consideration of social elements such as access to social support networks to support patients in managing their chronic pain was conspicuously absent from the approaches used. Conclusion Pain clinic practitioners readily embraced cognitive/behavioural based management strategies but relatively little consideration to the impact social factors played in managing chronic pain was reported. Consequently multidisciplinary pain clinics espousing a bio-psychosocial model of pain management may not be achieving their maximum potential

White paper – On the use of LiDAR data at AmeriFlux sites

Our aim is to inform the AmeriFlux community on existing and upcoming LiDAR technologies (atmospheric Doppler or Raman LiDAR often deployed at flux sites are not considered here), how it is currently used at flux sites, and how we believe it could, in the future, further contribute to the AmeriFlux vision. Heterogeneity in vegetation and ground properties at various spatial scales is omnipresent at flux sites, and 3D mapping of canopy, understory, and ground surface can help move the science forward

PEPFAR Public Health Evaluation -Care and Support -Phase I Uganda

Phase 1, a survey of 120 care facilities in Kenya and Uganda, found that over 90% of facilities provided some level of clinical, psychological,and preventive care. Pain control was very limited with paracetamol often the only analgesic. In focus group discussions, patients appreciated free care and positive attitudes from staff, but said that services would be improved by more staff, shorter queues, and reliable drug supplies

PEPFAR Public Health Evaluation - Care and Support - Phase 2 Uganda

Phase 2 consisted of a longitudinal cohort study to measure patient-reported outcomes of care and support, a costing survey, and qualitative interviews to understand patient and carer experiences

Neighborhood Effect Heterogeneity by Family Income and Developmental Period

Effects of disadvantaged neighborhoods on child educational outcomes likely depend on a family's economic resources and the timing of neighborhood exposures during the course of child development. This study investigates how timing of exposure to disadvantaged neighborhoods during childhood versus adolescence affects high school graduation and whether these effects vary across families with different income levels. It follows 6,137 children in the PSID from childhood through adolescence and overcomes methodological problems associated with the joint endogeneity of neighborhood context and family income by adapting novel counterfactual methods--a structural nested mean model estimated via two-stage regression with residuals--for time-varying treatments and time-varying effect moderators. Results indicate that exposure to disadvantaged neighborhoods, particularly during adolescence, has a strong negative effect on high school graduation and that this negative effect is more severe for children from poor families

Ionosphere-thermosphere coupling via global-scale waves: new insights from two-years of concurrent in situ and remotely-sensed satellite observations

Growing evidence indicates that a selected group of global-scale waves from the lower atmosphere constitute a significant source of ionosphere-thermosphere (IT, 100–600 km) variability. Due to the geometry of the magnetic field lines, this IT coupling occurs mainly at low latitudes (< 30°) and is driven by waves originating in the tropical troposphere such as the diurnal eastward propagating tide with zonal wave number s = −3 (DE3) and the quasi-3-day ultra-fast Kelvin wave with s = −1 (UFKW1). In this work, over 2 years of simultaneous in situ ion densities from Ion Velocity Meters (IVMs) onboard the Ionospheric Connection Explorer (ICON) near 590 km and the Scintillation Observations and Response of the Ionosphere to Electrodynamics (SORTIE) CubeSat near 420 km, along with remotely-sensed lower (ca. 105 km) and middle (ca. 220 km) thermospheric horizontal winds from ICON’s Michelson Interferometer for Global High-resolution Thermospheric Imaging (MIGHTI) are employed to demonstrate a rich spectrum of waves coupling these IT regions. Strong DE3 and UFKW1 topside ionospheric variations are traced to lower thermospheric zonal winds, while large diurnal s = 2 (DW2) and zonally symmetric (D0) variations are traced to middle thermospheric winds generated in situ. Analyses of diurnal tides from the Climatological Tidal Model of the Thermosphere (CTMT) reveal general agreement near 105 km, with larger discrepancies near 220 km due to in situ tidal generation not captured by CTMT. This study highlights the utility of simultaneous satellite measurements for studies of IT coupling via global-scale waves

Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years

From McKinlay, C. J. D., Alsweiler, J. M., Ansell, J. M., Anstice, N. S., Chase, J. G., Gamble, G. D., … Harding, J. E. (2015). Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years. New England Journal of Medicine, 373(16), 1507–1518. https://doi.org/10.1056/NEJMoa1504909 Copyright © 2015 Massachusetts Medical Society. Reprinted with permission.Neonatal hypoglycemia is a common and readily treatable risk factor for neurologic impairment in children. Although associations between prolonged symptomatic neonatal hypoglycemia and brain injury are well established,1 the effect of milder hypoglycemia on neurologic development is uncertain.2 Consequently, large numbers of newborns are screened and treated for low blood glucose concentrations, which involves heel-stick blood tests, substantial costs, and the possibility of iatrogenic harm. Under current guidelines,3 up to 30% of neonates are considered to be at risk for hypoglycemia, 15% receive a diagnosis of hypoglycemia, and approximately 10% require admission to a neonatal intensive care unit,4 costing an estimated $2.1 billion annually in the United States alone.5 Associated formula feeding and possible separation of mother and baby reduce breast-feeding rates,6 with potentially adverse effects on broader infant health and development. In addition, pain-induced stress in neonates, such as repeated heel sticks, may itself impair brain development.7 Thus, to determine appropriate glycemic thresholds for treatment, there have been repeated calls for studies of the effect of neonatal hypoglycemia on long-term development.2,8 We report the results of the Children with Hypoglycaemia and Their Later Development (CHYLD) study, a large prospective cohort study of term and late-preterm neonates born at risk for hypoglycemia. The study investigated the relation between the duration, frequency, and severity of low glucose concentrations in the neonatal period and neuropsychological development at 2 years.Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD069622), the Health Research Council of New Zealand (10-399), and the Auckland Medical Research Foundation (1110009)

Palliative care in urgent need of recognition and development in general practice: the example of Germany

Background: Specialist palliative care is being increasingly recognised and developed to improve end-of-life care in many developed countries. However, only a small proportion of the total number of patients with incurable, progressive diseases actually has direct contact with specialist palliative care practitioners. Using the German situation as an example, the main purpose of this paper is to argue that the emphasis on specialist palliative care services without a similar encouragement of primary palliative care will deliver a constrained service