Pain Screening in Primary Care

Pain screening has become an increasingly common practice in primary care, largely because pain screening has been adopted as a quality benchmark by the Joint Commission on Accreditation of Healthcare Organizations (JCAH0). The principal goal of universal pain screening is to systematically identify patients in need of additional assessment and treatment for pain. Although this practice is now widespread and mandatory in many primary care settings, it has not been adequately evaluated. This paper will describe 3 projects that were conducted to evaluate the effectiveness of pain screening in primary care: a literature review, a retrospective chart review, and a prospective observational study conducted in the University of North Carolina (UNC) Internal Medicine Clinic. We used criteria developed by the US Preventive Services Task Force (USPSTF) to guide our evaluations. These criteria for a good screening test are: 1) the test must be sufficiently accurate and capable of detecting a condition earlier than routine care and 2) the likelihood of favorable outcomes should be improved by screening and early treatment. We conducted a literature review to determine whether studies were available to assess either of these criteria. We then conducted a retrospective chart review and a prospective observational study to evaluate the first of the two USPSTF criteria, the accuracy of pain screening as a way to identify patients in need of additional assessment and treatment.Master of Public Healt

Proximate factors underpinning receiver responses to deceptive false alarm calls in wild tufted capuchin monkeys: is it counterdeception?

Previous research demonstrates that tufted capuchin monkeys use terrestrial predator alarm calls in a functionally deceptive manner to distract conspecifics when feeding on contestable resources, although the success of this tactic is limited because listeners frequently ignore these calls when given in such situations. While this decreased response rate is suggestive of a counterstrategy to deception by receivers, the proximate factors underpinning the behavior are unclear. The current study aims to test if the decreased response rate to alarm calls in competitive contexts is better explained by the perception of subtle acoustic differences between predator-elicited and deceptive false alarms, or by receivers varying their responses based on the context in which the signal is received. This was tested by first examining the acoustic structure of predator-elicited and deceptive false alarms for any potentially perceptible acoustic differences, and second by comparing the responses of capuchins to playbacks of each of predator-elicited and false alarms, played back in noncompetitive contexts. The results indicate that deceptive false alarms and predator-elicited alarms show, at best, minimal acoustic differences based on the structural features measured. Likewise, playbacks of deceptive false alarms elicited antipredator reactions at the same rate as did predator-elicited alarms, although there was a nonsignificant tendency for false alarms to be more likely to elicit escape reactions. The lack of robust acoustic differences together with the high response rate to false alarms in noncompetitive contexts suggests that the context in which the signal is received best explains receiver responses. It remains unclear, however, if listeners ascribe different meanings to the calls based on context, or if they generally ignore all signals in competitive contexts. Whether or not the decreased response rate of receivers directly stems from the deceptive use of the calls cannot be determined until these latter possibilities are rigorously tested

Operative Environment

Postoperative SSIs are believed to occur via bacterial inoculation at the time of surgery or as a result of bacterial contamination of the wound via open pathways to the deep tissue layers.1–3 The probability of SSI is reflected by interaction of parameters that can be categorized into three major groups.2 The first group consists of factors related to the ability of bacteria to cause infection and include initial inoculation load and genetically determined virulence factors that are required for adherence, reproduction, toxin production, and bypassing host defense mechanisms. The second group involves those factors related to the defense capacity of the host including local and systemic defense mechanisms. The last group contains environmental determinants of exposure such as size, time, and location of the surgical wound that can provide an opportunity for the bacteria to enter the surgical wound, overcome the local defense system, sustain their presence, and replicate and initiate local as well as systemic inflammatory reactions of the host. The use of iodine impregnated skin incise drapes shows decreased skin bacterial counts but no correlation has been established with SSI. However, no recommendations regarding the use of skin barriers can be made (see this Workgroup, Question 27)

Nanoparticles for bone tissue engineering

Tissue engineering (TE) envisions the creation of functional substitutes for damaged tissues through integrated solutions, where medical, biological, and engineering principles are combined. Bone regeneration is one of the areas in which designing a model that mimics all tissue properties is still a challenge. The hierarchical structure and high vascularization of bone hampers a TE approach, especially in large bone defects. Nanotechnology can open up a new era for TE, allowing the creation of nanostructures that are comparable in size to those appearing in natural bone. Therefore, nanoengineered systems are now able to more closely mimic the structures observed in naturally occurring systems, and it is also possible to combine several approaches - such as drug delivery and cell labeling - within a single system. This review aims to cover the most recent developments on the use of different nanoparticles for bone TE, with emphasis on their application for scaffolds improvement; drug and gene delivery carriers, and labeling techniques.This study was funded by QREN (ON.2 - NORTE-01-0124-FEDER-000018), as well as the European Union’s FP7 Programme under grant agreement number REGPOTCT2012-316331-POLARIS. Sılvia Vieira was awarded an FCT PhD scholarship (SFRH/BD/102710/2014). The FCT distinction attributed to J.M.O. under the Investigator FCT program (IF/00423/2012 and IF/01285/2015) is also greatly acknowledged.info:eu-repo/semantics/publishedVersio

Difficulties when Assessing Birdsong Learning Programmes under Field Conditions: A Re-Evaluation of Song Repertoire Flexibility in the Great Tit

There is a remarkable diversity of song-learning strategies in songbirds. Establishing whether a species is closed- or open-ended is important to be able to interpret functional and evolutionary consequences of variation in repertoire size. Most of our knowledge regarding the timing of vocal learning is based on laboratory studies, despite the fact that these may not always replicate the complex ecological and social interactions experienced by birds in the wild. Given that field studies cannot provide the experimental control of laboratory studies, it may not be surprising that species such as the great tit that were initially assumed to be closed-ended learners have later been suggested to be open-ended learners. By using an established colour-ringed population, by following a standardized recording protocol, and by taking into account the species' song ecology (using only recordings obtained during peak of singing at dawn), we replicated two previous studies to assess song repertoire learning and flexibility in adult wild great tits elicited by social interactions. First, we performed a playback experiment to test repertoire plasticity elicited by novel versus own songs. Additionally, in a longitudinal study, we followed 30 males in two consecutive years and analysed whether new neighbours influenced any change in the repertoire. Contrary to the previous studies, song repertoire size and composition were found to be highly repeatable both between years and after confrontation with a novel song. Our results suggest that great tits are closed-ended learners and that their song repertoire probably does not change during adulthood. Methodological differences that may have led to an underestimation of the repertoires or population differences may explain the discrepancy in results with previous studies. We argue that a rigorous and standardized assessment of the repertoire is essential when studying age- or playback-induced changes in repertoire size and composition under field conditions

Bayesian paternity analysis and mating patterns in a parasitic nematode, Trichostrongylus tenuis

Mating behaviour is a fundamental aspect of the evolutionary ecology of sexually reproducing species, but one that has been under-researched in parasitic nematodes. We analysed mating behaviour in the parasitic nematode Trichostrongylus tenuis by performing a paternity analysis in a population from a single red grouse host. Paternity of the 150 larval offspring of 25 mothers (sampled from one of the two host caeca) was assigned among 294 candidate fathers (sampled from both caeca). Each candidate father's probability of paternity of each offspring was estimated from 10-locus microsatellite genotypes. Seventy-six (51%) offspring were assigned a father with a probability of >0.8, and the estimated number of unsampled males was 136 (95% credible interval (CI) 77-219). The probability of a male from one caecum fathering an offspring in the other caecum was estimated as 0.024 (95% CI 0.003-0.077), indicating that the junction of the caeca is a strong barrier to dispersal. Levels of promiscuity (defined as the probability of two of an adult's offspring sharing only one parent) were high for both sexes. Variance in male reproductive success was moderately high, possibly because of a combination of random mating and high variance in post-copulatory reproductive success. These results provide the first data on individual mating behaviour among parasitic nematodes

Coupling models of cattle and farms with models of badgers for predicting the dynamics of bovine tuberculosis (TB)

Bovine TB is a major problem for the agricultural industry in several countries. TB can be contracted and spread by species other than cattle and this can cause a problem for disease control. In the UK and Ireland, badgers are a recognised reservoir of infection and there has been substantial discussion about potential control strategies. We present a coupling of individual based models of bovine TB in badgers and cattle, which aims to capture the key details of the natural history of the disease and of both species at approximately county scale. The model is spatially explicit it follows a very large number of cattle and badgers on a different grid size for each species and includes also winter housing. We show that the model can replicate the reported dynamics of both cattle and badger populations as well as the increasing prevalence of the disease in cattle. Parameter space used as input in simulations was swept out using Latin hypercube sampling and sensitivity analysis to model outputs was conducted using mixed effect models. By exploring a large and computationally intensive parameter space we show that of the available control strategies it is the frequency of TB testing and whether or not winter housing is practised that have the most significant effects on the number of infected cattle, with the effect of winter housing becoming stronger as farm size increases. Whether badgers were culled or not explained about 5%, while the accuracy of the test employed to detect infected cattle explained less than 3% of the variance in the number of infected cattle

Creating Resilient Public Spaces – a Global Perspective on the Conditions for Integrated Urban Development

Urban public spaces play a central role in the regeneration of cities: their inclusive and sustainable design is crucial for creating equitable and climate-resilient urban environments. This paper presents the results of an applied research project that involved case studies in three cities on three continents - Dhaka, Maputo, and Santo Domingo – where the team of superwien, in partnership with local academic partners, developed designs for public spaces using an integrated approach. The participatory design process was implemented during the worldwide COVID-19 pandemic in 2021 and 2022 through academic urban living labs in our partner cities. Urban strategies and design solutions for the regeneration of public space were co-created with local communities through a moderated, innovative planning and design process. Additionally, accompanying research was conducted to explore the need for integrated planning approaches in urban regeneration that address multi-sectoral challenges. This approach aimed to ensure that the resulting proposals were holistic and responsive to the specific needs and aspirations of the local communities and urban environments in which they were implemented. The case studies encompassed a range of sites reflecting diverse urban contexts: the urban lake of Shahjahanpur Jheel in Dhaka that had deteriorated into a dump site, central public spaces in informal neighbourhoods surrounding the historic centre of Maputo, and a central expressway in Santo Domingo. In intensive dialogue with the local populations, their needs and aspirations for these places were identified. Co- creation opportunities and place-making events empowered residents and local entrepreneurs to take an active role in the transformation of their neighbourhoods. Established participation tools were adapted to each local context and new techniques were developed for specific user groups. Additionally, young professionals were included in the design process through cooperation with local universities. Academic partnerships and the cooperation with local city administrations also supported capacity building and knowledge exchange. The results of the process included integrated urban strategies, urban designs, and architectural solutions, completed by cost estimates for implementation. During the transnational work process, we identified seven overarching challenges that need to be addressed to transform public spaces with an integrated approach: inclusive mobility, housing, climate change adaptation, local economy, governance, as well as gender-sensitive and participatory planning. Considering these aspects in their specific local contexts supports the creation of lively public spaces for the development of inclusive, resilient, and sustainable cities. This paper presents how the challenges were identified and addressed through the applied research approach for the design of public spaces in Dhaka, Maputo and Santo Domingo

Projected WIMP sensitivity of the LUX-ZEPLIN dark matter experiment

LUX-ZEPLIN (LZ) is a next-generation dark matter direct detection experiment that will operate 4850 feet underground at the Sanford Underground Research Facility (SURF) in Lead, South Dakota, USA. Using a two-phase xenon detector with an active mass of 7 tonnes, LZ will search primarily for low-energy interactions with weakly interacting massive particles (WIMPs), which are hypothesized to make up the dark matter in our galactic halo. In this paper, the projected WIMP sensitivity of LZ is presented based on the latest background estimates and simulations of the detector. For a 1000 live day run using a 5.6-tonne fiducial mass, LZ is projected to exclude at 90% confidence level spin-independent WIMP-nucleon cross sections above 1.4×10-48 cm2 for a 40 GeV/c2 mass WIMP. Additionally, a 5σ discovery potential is projected, reaching cross sections below the exclusion limits of recent experiments. For spin-dependent WIMP-neutron(-proton) scattering, a sensitivity of 2.3×10-43 cm2 (7.1×10-42 cm2) for a 40 GeV/c2 mass WIMP is expected. With underground installation well underway, LZ is on track for commissioning at SURF in 2020