The role of peer communication in the socialization of adolescents' pain experiences: a qualitative investigation.

BACKGROUND: Recurrent pain is a common complaint among adolescents. Children learn to resolve or cope with pain largely through family dynamics, particularly maternal influences. By adolescence, young people possess an array of pain behaviors, the culmination of multiple opportunities for modeling and reinforcement of attitudes and beliefs about pain. Adolescence is a time of increased autonomy characterized by, among other complex factors, significant increases in peer influence. Although peers are influential in health-risk behavior, little is known how peers impact adolescents' pain experience. The present study explored the role of peers in adolescents' attitudes toward pain, pain behaviors and over-the-counter analgesics. METHODS: Sixty-minute focus groups were conducted with a sample 24 junior high school students from Halifax, Nova Scotia, Canada (11 male: mean age = 13.45 years, range = 12-15 years; 13 female: mean age = 13.31 years, range = 12-15 years). Participants were randomly assigned to one of five same-gender focus groups designed to explore a wide breadth and depth of information. Sessions were run until theoretical data saturation. Textual data, from transcribed audiotapes, were analyzed with the constant comparative method. RESULTS: Peer influences were apparent in how adolescents communicate about pain and how those communications effect pain expression. Overt pain responses to injury were primarily contextual and depended on perceived threats to peer-time and pain severity. Adolescents were intolerant of peers' pain behaviors when the cause was perceived as not severe. These attitudes impacted how adolescents responded to their own pain; males were careful not to express embarrassing pain in front of peers, females felt no restrictions on pain talk or pain expression. Evidence for peer influence on attitudes toward OTC analgesics was apparent in perceptions of over-use and ease of access. Findings are discussed within the context of social information-processing and gender role expectations. CONCLUSION: Little research has addressed how young people experience pain within the context of the psychosocial influences that dominate during adolescence. The findings provide some insight into the role of peer influences via verbal and non-verbal communication, in adolescents' pain experience. This exploratory study is a necessary first step in understanding the socialization of adolescents' pain experiences

Bayesian Gaussian Copula Factor Models for Mixed Data.

Gaussian factor models have proven widely useful for parsimoniously characterizing dependence in multivariate data. There is a rich literature on their extension to mixed categorical and continuous variables, using latent Gaussian variables or through generalized latent trait models acommodating measurements in the exponential family. However, when generalizing to non-Gaussian measured variables the latent variables typically influence both the dependence structure and the form of the marginal distributions, complicating interpretation and introducing artifacts. To address this problem we propose a novel class of Bayesian Gaussian copula factor models which decouple the latent factors from the marginal distributions. A semiparametric specification for the marginals based on the extended rank likelihood yields straightforward implementation and substantial computational gains. We provide new theoretical and empirical justifications for using this likelihood in Bayesian inference. We propose new default priors for the factor loadings and develop efficient parameter-expanded Gibbs sampling for posterior computation. The methods are evaluated through simulations and applied to a dataset in political science. The models in this paper are implemented in the R package bfa

Historic landmarks in clinical transplantation: Conclusions from the consensus conference at the University of California, Los Angeles

The transplantation of organs, cells, and tissues has burgeoned during the last quarter century, with the development of multiple new specialty fields. However, the basic principles that made this possible were established over a three-decade period, beginning during World War II and ending in 1974. At the historical consensus conference held at UCLA in March 1999, 11 early workers in the basic science or clinical practice of transplantation (or both) reached agreement on the most significant contribution of this era that ultimately made transplantation the robust clinical discipline it is today. These discoveries and achievements are summarized here is six tables and annotated with references

Sectoral Issues and the Multilateral Framework for Trade in Services: An Overview

summary Increased opportunity for developing countries to expand trade in services is one objective of attempts to liberalise trade in services. However, efforts in this direction are continually impeded by the specificity required in trying to effect a workable multilateral framework, The heterogeneity of the services sector does not lend itself to an easily negotiable framework. This article addresses two major issues on this topic: (i) the market structure of trade in services and the basis of comparative advantage of developed countries; (ii) the desirability of a multilateral negotiating framework which takes into account the strategic importance of particular service sectors to growth and development and the present state of international trade and draft segments of the set. Résumé Vue d'ensemble sur les problèmes de secteurs et le cadre multilatéral pour les industries de services L'augmentation des possibilités pour les pays en voie de développement d'élargir le commerce des industries de services constitute l'objectif des tentatives de libéralisation du commerce des industries de services. Cependant, les efforts allant dans cette direction sont continuellement entravés par le besoin d'indications précises que demande la réalisation d'une structure multilatérale. L'hétérogénéité du secteur des services ne se prête pas à la formation d'une structure aisément négotiable. Cet article aborde deux problèmes principaux liés à ce thàme: 1) La structure du marché des industries de services et les conditions des avantages reliatifs des pavs developpés 2) L'avantage d'une structure multilatérale de négotiations, qui tient compte de l'importance stratégique de certains secteurs des services pour le développement, et de l'état actuel du commerce international et des segments sommaires de l'ensemble. Resumen Una revisión de los problemas sectoriales y el marco multilateral para el comercio de servicios Uno de los objetivos de los intentos de los países en desarrollo de liberalizar el comercio de los servicios es mejorar sus oportunidades en este rubro. No obstante, la especificidad requerida para establecer un marco multilateral viable conspira constantemente en contra de los esfuerzos que se despliegan en este sentido. La heterogeneidad del sector servicios, por si misma, no se presta fácilmente para un marco negociable. Este artículo enfoca dos problemas básicos en este tópico: i) la estructura de mercado del comercio de servicios y la base de las ventajas comparativas de los países en desarrollo. ii) la conveniencia de un marco multilateral negociable que considere la importancia estratégica de determinados sectores de servicios y, segmentos de éste en el crecimiento y desarrollo y el estado actual del comercio internacional

The amygdala: securing pleasure and avoiding pain

The amygdala has traditionally been associated with fear, mediating the impact of negative emotions on memory. However, this view does not fully encapsulate the function of the amygdala, nor the impact that processing in this structure has on the motivational limbic corticostriatal circuitry of which it is an important structure. Here we discuss the interactions between different amygdala nuclei with cortical and striatal regions involved in motivation; interconnections and parallel circuitries that have become increasingly understood in recent years. We review the evidence that the amygdala stores memories that allow initially motivationally neutral stimuli to become associated through pavlovian conditioning with motivationally relevant outcomes which, importantly, can be either appetitive (e.g. food) or aversive (e.g. electric shock). We also consider how different psychological processes supported by the amygdala such as conditioned reinforcement and punishment, conditioned motivation and suppression, and conditioned approach and avoidance behavior, are not only psychologically but also neurobiologically dissociable, being mediated by distinct yet overlapping neural circuits within the limbic corticostriatal circuitry. Clearly the role of the amygdala goes beyond encoding aversive stimuli to also encode the appetitive, requiring an appreciation of the amygdala's mediation of both appetitive and fearful behavior through diverse psychological processes.This work was conducted in the Behavioural and Clinical Neuroscience Institute, a joint initiative funded by the UK Medical Research Council (MRC) and the Wellcome Trust, in the Department of Psychology at the University of Cambridge. Anushka B. P. Fernando was supported by an MRC CASE studentship, Jennifer E. Murray was supported by an MRC Programme Grant (no. G1002231), and Amy L. Milton is the Ferreras-Willetts Fellow in Neuroscience at Downing College, Cambridge

Patient-maintained sedation for oral surgery using a target-controlled infusion of propofol - a pilot study

OBJECTIVE: To assess the safety and efficacy of a new patient-maintained propofol system for conscious sedation in dentistry. DESIGN: Prospective clinical trial SETTING: Department of Sedation, Glasgow Dental Hospital and School, 2001 SUBJECTS AND METHODS: Patients scheduled for oral surgery with conscious sedation. Exclusions included ASA IV -V, inability to use the handset, opioid use and severe respiratory disease. INTERVENTIONS: Patients were given intravenous propofol to a level of 1.0 microg/ml (reducing from 1.5 microg/ml) using a target controlled infusion system, they then controlled their sedation level by double-clicking a handset which on each activation increased the propofol concentration by 0.2 microg/ml. MAIN OUTCOME MEASURES: Oxygen saturation, patient satisfaction, and surgeon satisfaction. RESULTS: Twenty patients were recruited, 16 female and four male. Nineteen patients completed sedation and treatment successfully. Mean lowest oxygen saturation was 94%. No patients were over-sedated. All patients successfully used the system to maintain a level of sedation adequate for their comfort. Patient and surgeon satisfaction were consistently high. CONCLUSIONS: Initial experience with this novel system has confirmed safety, patient satisfaction and surgeon satisfaction

US Caribbean fish trap fishery socioeconomic study

Concerns over the potential impacts of trap fishing on coral reefs and associated habitats prompted a socioeconomic study to characterize the U.S. Caribbean fish trap fishery in anticipation of management actions. Stratified random interviews of one hundred fishermen revealed the presence of a diverse fishery, with appreciable inter-island differences in levels of fishing dependence, fishing practices, and capital investment. High levels of fishing dependence Were observed among fishermen in the U.S. Virgin Islands, whereas Puerto Rican fishermen exhibited a more diversified livelihood strategy. Fishermen from St. Croix derived 62% of their household income from fish traps, significantly more than fishermen from St. Thomas/St. John and Puerto Rico, who derived 45% and 41%, respectively, of their household incomes from fish traps. The St. Thomas/St. John fleet was also larger and more capital-intensive than the Crucian and Puerto Rican fleets. This structural heterogeneity suggests that fishermen from the various islands may respond differently to the same regulatory constraint. Thus, targeted policies may be necessary to improve the socioeconomic performance of the fishery and the political acceptability of management actions