Factors that Influence Providers’ Pain Treatment Decisions

poster abstractMedical and non-medical factors influence providers’ pain treatment decisions. Among these, patient demographic characteristics and substance use have received particular attention. However, few empirical studies have examined the specific factors providers rely on for their pain treatment decisions. This study employed lens model methodology to examine the factors that providers reportedly used, actually used, and would have used (if available) to make pain treatment decisions. We hypothesized that: (1) providers would rate patients’ pain history and description of pain as the most influential factors provided in the clinical vignettes, and (2) providers would rate patients’ substance use history as the most important factor not provided in the vignettes. 100 providers viewed 16 computer-simulated patients; each included a picture with accompanying text describing the patient’s medical condition. After making multi-modal treatment ratings for each patient, providers indicated the factors they used to make treatment decisions and the factors they would have used (if available) to make decisions. Results indicated that most providers reported being influenced by patients’ pain histories (98%) and descriptions (96%), whereas fewer reported using patients' movement (75%) or demographic characteristics (62%). Providers reported that they wanted additional information on patients’ treatment histories (98%), current/average pain (96%), and drug use (94%) to guide their decisions. Exploratory analyses indicated that, compared to providers who were not statistically influenced by patient demographics, a slightly greater proportion of providers who were statistically influenced by patient demographics wanted additional information about patients’ alcohol use to inform their decisions, χ2 (1) = 3.09, p = .08. These results suggest that providers prioritize both objective and subjective information about patients’ pain conditions, as well as patients’ substance use behaviors, when making treatment decisions. These findings have important implications for pain management and may lead to improved patient safety and care

Mobile phone-based interventions for improving contraception use (Review)

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine wheth er inter ventions delivered by mobile phone can improve contraception us

A Frequency Tuning Method for a Planar Inverted-F Antenna

A novel method is presented for electrically tuning the frequency of a planar inverted-F antenna (PIFA). A tuning circuit, comprising an RF switch and discrete passive components, has been completely integrated into the antenna element, which is thus free of dc wires. The proposed tuning method has been demonstrated with a dual-band PIFA capable of operating in four frequency bands. The antenna covers the GSM850, GSM900, GSM1800, PCS1900 and UNITS frequency ranges with over 40% total efficiency. The impact of the tuning circuit on the antenna's efficiency and radiation pattern have been experimentally studied through comparison with the performance of a reference antenna not incorporating the tuning circuit. The proposed frequency tuning concept can be extended to more complex PIFA structures as well as other types of antennas to give enhanced electrical performance.</p

Specific Internalisation of Gold Nanoparticles into Engineered Porous Protein Cages via Affinity Binding

Porous protein cages are supramolecular protein self-assemblies presenting pores that allow the access of surrounding molecules and ions into their core in order to store and transport them in biological environments. Protein cages’ pores are attractive channels for the internalisation of inorganic nanoparticles and an alternative for the preparation of hybrid bioinspired nanoparticles. However, strategies based on nanoparticle transport through the pores are largely unexplored, due to the difficulty of tailoring nanoparticles that have diameters commensurate with the pores size and simultaneously displaying specific affinity to the cages’ core and low non-specific binding to the cages’ outer surface. We evaluated the specific internalisation of single small gold nanoparticles, 3.9 nm in diameter, into porous protein cages via affinity binding. The E2 protein cage derived from the Geobacillus stearothermophilus presents 12 pores, 6 nm in diameter, and an empty core of 13 nm in diameter. We engineered the E2 protein by site-directed mutagenesis with oligohistidine sequences exposing them into the cage’s core. Dynamic light scattering and electron microscopy analysis show that the structures of E2 protein cages mutated with bis- or penta-histidine sequences are well conserved. The surface of the gold nanoparticles was passivated with a self-assembled monolayer made of a mixture of short peptidols and thiolated alkane ethylene glycol ligands. Such monolayers are found to provide thin coatings preventing non-specific binding to proteins. Further functionalisation of the peptide coated gold nanoparticles with Ni2+ nitrilotriacetic moieties enabled the specific binding to oligohistidine tagged cages. The internalisation via affinity binding was evaluated by electron microscopy analysis. From the various mutations tested, only the penta-histidine mutated E2 protein cage showed repeatable and stable internalisation. The present work overcomes the limitations of currently available approaches and provides a new route to design tailored and well-controlled hybrid nanoparticles

Dynamic modelling and response characteristics of a magnetic bearing rotor system including auxiliary bearings

Auxiliary bearings are a critical feature of any magnetic bearing system. They protect the soft iron core of the magnetic bearing during an overload or failure. An auxiliary bearing typically consists of a rolling element bearing or bushing with a clearance gap between the rotor and the inner race of the support. The dynamics of such systems can be quite complex. It is desired to develop a rotor-dynamic model and assess the dynamic behavior of a magnetic bearing rotor system which includes the effects of auxiliary bearings. Of particular interest is the effects of introducing sideloading into such a system during failure of the magnetic bearing. A model is developed from an experimental test facility and a number of simulation studies are performed. These results are presented and discussed

Examining Gender Differences in Pain Treatment Recommendations

poster abstractUnderstanding how pain treatment decisions are made has important clinical implications for healthcare. Research suggests that men and women receive disparate pain care, however, little is known about the specific treatment recommendations that are differentially made for men and women. The purpose of this study was to examine differences between the types of pain treatments recommended for men and women. Undergraduate psychology students from Indiana University-Purdue University Indianapolis (IUPUI) and the University of North Texas (UNT) (n=621) made treatment recommendations for 8 chronic pain patients after reading a vignette describing the patient’s pain and watching a video of each patient completing a pain-inducing task (i.e., transition between sitting and standing). Participants made pain treatment recommendations for each patient using separate 0-100 visual analogue scales (VASs). Dependent samples t-tests indicated that participants were more likely to recommend workplace accommodations (t(620)= -3.05, p= .002, d= 0.17), disability compensation (t(620)= -7.77, p< .001, d= 0.44), and opioid medications (t(620)= -5.16, p< .001, d= 0.29) for men compared to women. Moreover, participants were more likely to recommend psychological therapy (t(620)= 4.59, p< .001, d= 0.26), rest (t(620)= 7.80, p< .001, d= 0.44), and diet/exercise (t(620)= 2.97, p= .003, d= 0.17) for women compared to men. These results are consistent with social psychological theories of gender-based stereotyping and suggest that men’s pain was perceived to be more legitimate, severe, and disabling than was women’s pain. Future studies are needed to examine how these differences affect pain outcomes and whether knowledge of these factors can improve training for future health care providers

Examining Influential Factors in Providers’ Chronic Pain Treatment Decisions: A Comparison of Physicians and Medical Students

Reports have found that chronic pain management guidelines are unclear and conflicting. Due to this confusion, it is critical to understand factors that influence providers’ treatment decisions for chronic pain. Little is known about which factors providers use to make treatment decisions or whether providers of different training levels endorse using similar factors. The purpose of this study was to examine the factors that providers report using to make their chronic pain treatment decisions. We hypothesized that providers would: (1) prioritize objective factors over subjective factors, (2) be particularly interested in information about patients’ substance use, and (3) endorse using different factors depending on their training level (physicians vs. medical students). Eighty-five providers (35 medical students, 50 physicians) viewed 16 computer-simulated patients; each included a picture with text describing the patients’ condition (i.e., chronic lower back pain, open to any treatment, presence/absence of depression). After making treatment decisions, participants selected from a list the factors they used and would have used (if the information had been available) to make their treatment decisions. Most providers reported being influenced by patients’ pain histories (97.6%) and pain descriptions (95.3%). Providers indicated they would have used information about patients’ previous treatments (97.6%), average pain ratings (96.5%), and current pain (96.5%) had this information been available. Compared to physicians, medical students endorsed more often that they would have used patients’ employment and/or disability status (p<.01), illicit drug use (p=.09), and alcohol use (p=.08) to make treatment decisions. These results indicate that providers rely on objective and subjective information to make pain treatment decisions, and compared to physicians, medical students place a stronger emphasis on patients’ substance abuse and social history when making treatment decisions. Future studies should examine additional provider and patient factors that influence decisions for specific pain treatment options

Women's perspectives on termination service delivery in Vietnam: a cross-sectional survey in three provinces.

OBJECTIVE: To explore the perspectives of abortion service users regarding termination methods and abortion service delivery in Vietnam. MATERIALS AND METHODS: Structured exit interviews were conducted between August and November 2011 with women who underwent termination of pregnancy at 62 public health facilities in Hanoi, Khanh Hoa, and Ho Chi Minh City in Vietnam. All women presenting for termination during the study period were recruited to participate in the study. Following their abortion, women were asked about their perspectives on abortion service delivery and attributes of medical abortion (MA) versus manual vacuum aspiration (MVA). Multiple logistic regression was used to assess the association between current method uptake and each attribute. RESULTS: A total of 1,233 women were included in the survey: 541 (43.9%) from Hanoi, 163 (13.2%) from Khanh Hoa, and 529 (42.9%) from Ho Chi Minh: 23.1% underwent MA; 78.9% reported that women should be given a choice between MA and MVA; and 77.6% thought that abortion services were accessible. Among the 48% who responded, 30.1% thought that MA should be made available at primary/secondary health care facilities. Among women who had previously undergone both methods, women who reported that MA "feels more natural" (like a menstrual regulation/period) were more likely to choose MA for their current abortion (odds ratio 2.15, 95% confidence interval 1.26-3.69). CONCLUSION: MA uptake is significantly lower than MVA uptake. Further insights to women's perceptions of MA in Vietnam could help improve abortion service delivery in the country

A novel dual-ring multi-layer circular polarized antenna

A novel circular polarized antenna structure capable of high radiation efficiency, and suitable for use in multilayer microwave circuits is presented. The antenna uses dual ring feed system to enhance radiation. Data is provided for a prototype antenna working at 10 GHz.</p