Just how much does it cost? A cost study of chronic pain following cardiac surgery

Objective: The study objective was to determine use of pain-related health care resources and associated direct and indirect costs over a two-year period in cardiac surgery patients who developed chronic post-surgical pain (CPSP). Methods: This multicentric observational prospective study recruited patients prior to cardiac surgery; these patients completed research assistant-administered questionnaires on pain and psychological characteristics at 6, 12 and 24 months post-operatively. Patients reporting CPSP also completed a one-month pain care record (PCR) (self-report diary) at each follow-up. Data were analyzed using descriptive statistics, multivariable logistic regression models, and generalized linear models with log link and gamma family adjusting for sociodemographic and pain intensity. Results: Out of 1,247 patients, 18%, 13%, and 9% reported experiencing CPSP at 6, 12, and 24 months, respectively. Between 16% and 28% of CPSP patients reported utilizing health care resources for their pain over the follow-up period. Among all CPSP patients, mean monthly pain-related costs were CAN$207 at 6 months and significantly decreased thereafter. More severe pain and greater levels of pain catastrophizing were the most consistent predictors of health care utilization and costs. Discussion: Health care costs associated with early management of CPSP after cardiac surgery seem attributable to a minority of patients and decrease over time for most of them. Results are novel in that they document for the first time the economic burden of CPSP in this population of patients. Longer follow-up time that would capture severe cases of CPSP as well as examination of costs associated with other surgical populations are warranted. Summary: Economic burden of chronic post-surgical pain may be substantial but few patients utilize resources. Health utilization and costs are associated with pain and psychological characteristics

Pseudogap phase of cuprate superconductors confined by Fermi surface topology

The properties of cuprate high-temperature superconductors are largely shaped by competing phases whose nature is often a mystery. Chiefly among them is the pseudogap phase, which sets in at a doping $p^*$ that is material-dependent. What determines $p^*$ is currently an open question. Here we show that the pseudogap cannot open on an electron-like Fermi surface, and can only exist below the doping $p_{FS}$ at which the large Fermi surface goes from hole-like to electron-like, so that $p^*$ $\leq$ $p_{FS}$. We derive this result from high-magnetic-field transport measurements in La$_{1.6-x}$Nd$_{0.4}$Sr$_x$CuO$_4$ under pressure, which reveal a large and unexpected shift of $p^*$ with pressure, driven by a corresponding shift in $p_{FS}$. This necessary condition for pseudogap formation, imposed by details of the Fermi surface, is a strong constraint for theories of the pseudogap phase. Our finding that $p^*$ can be tuned with a modest pressure opens a new route for experimental studies of the pseudogap.Comment: 15 pages, 5 figures, 7 supplemental figure

Broken rotational symmetry in the pseudogap phase of a high-Tc superconductor

The nature of the pseudogap phase is a central problem in the quest to understand high-Tc cuprate superconductors. A fundamental question is what symmetries are broken when that phase sets in below a temperature T*. There is evidence from both polarized neutron diffraction and polar Kerr effect measurements that time- reversal symmetry is broken, but at temperatures that differ significantly. Broken rotational symmetry was detected by both resistivity and inelastic neutron scattering at low doping and by scanning tunnelling spectroscopy at low temperature, but with no clear connection to T*. Here we report the observation of a large in-plane anisotropy of the Nernst effect in YBa2Cu3Oy that sets in precisely at T*, throughout the doping phase diagram. We show that the CuO chains of the orthorhombic lattice are not responsible for this anisotropy, which is therefore an intrinsic property of the CuO2 planes. We conclude that the pseudogap phase is an electronic state which strongly breaks four-fold rotational symmetry. This narrows the range of possible states considerably, pointing to stripe or nematic orders.Comment: Published version. Journal reference and DOI adde

Conducting gender-based analysis of existing databases when self-reported gender data are unavailable: the GENDER Index in a working population

Objectives Growing attention has been given to considering sex and gender in health research. However, this remains a challenge in the context of retrospective studies where self-reported gender measures are often unavailable. This study aimed to create and validate a composite gender index using data from the Canadian Community Health Survey (CCHS). Methods According to scientific literature and expert opinion, the GENDER Index was built using several variables available in the CCHS and deemed to be gender-related (e.g., occupation, receiving child support, number of working hours). Among workers aged 18–50 years who had no missing data for our variables of interest (n = 29,470 participants), propensity scores were derived from a logistic regression model that included gender-related variables as covariates and where biological sex served as the dependent variable. Construct validity of propensity scores (GENDER Index scores) were then examined. Results When looking at the distribution of the GENDER Index scores in males and females, they appeared related but partly independent. Differences in the proportion of females appeared between groups categorized according to the GENDER Index scores tertiles (p < 0.0001). Construct validity was also examined through associations between the GENDER Index scores and gender-related variables identified a priori such as choosing/avoiding certain foods because of weight concerns (p < 0.0001), caring for children as the most important thing contributing to stress (p = 0.0309), and ability to handle unexpected/difficult problems (p = 0.0375). Conclusion The GENDER Index could be useful to enhance the capacity of researchers using CCHS data to conduct gender-based analysis among populations of workers

Nernst effect of iron pnictide and cuprate superconductors: signatures of spin density wave and stripe order

The Nernst effect has recently proven a sensitive probe for detecting unusual normal state properties of unconventional superconductors. In particular, it may sensitively detect Fermi surface reconstructions which are connected to a charge or spin density wave (SDW) ordered state, and even fluctuating forms of such a state. Here we summarize recent results for the Nernst effect of the iron pnictide superconductor $\rm LaO_{1-x}F_xFeAs$, whose ground state evolves upon doping from an itinerant SDW to a superconducting state, and the cuprate superconductor $\rm La_{1.8-x}Eu_{0.2}Sr_xCuO_4$ which exhibits static stripe order as a ground state competing with the superconductivity. In $\rm LaO_{1-x}F_xFeAs$, the SDW order leads to a huge Nernst response, which allows to detect even fluctuating SDW precursors at superconducting doping levels where long range SDW order is suppressed. This is in contrast to the impact of stripe order on the normal state Nernst effect in $\rm La_{1.8-x}Eu_{0.2}Sr_xCuO_4$. Here, though signatures of the stripe order are detectable in the temperature dependence of the Nernst coefficient, its overall temperature dependence is very similar to that of $\rm La_{2-x}Sr_xCuO_4$, where stripe order is absent. The anomalies which are induced by the stripe order are very subtle and the enhancement of the Nernst response due to static stripe order in $\rm La_{1.8-x}Eu_{0.2}Sr_xCuO_4$ as compared to that of the pseudogap phase in $\rm La_{2-x}Sr_xCuO_4$, if any, is very small.Comment: To appear in: 'Properties and applications of thermoelectric materials - II', V. Zlatic and A. Hewson, editors, Proceedings of NATO Advanced Research Workshop, Hvar, Croatia, September 19 -25, 2011, NATO Science for Peace and Security Series B: Physics and Biophysics, (Springer Science+Business Media B.V. 2012

Expansion of the Tetragonal Magnetic Phase with Pressure in the Iron Arsenide Superconductor Ba₁₋ₓKₓFe₂As₂

In the temperature-concentration phase diagram of most iron-based superconductors, antiferromagnetic order is gradually suppressed to zero at a critical point, and a dome of superconductivity forms around that point. The nature of the magnetic phase and its fluctuations is of fundamental importance for elucidating the pairing mechanism. In Ba1-xKxFe2As2 and Ba1-xNaxFe2As2, it has recently become clear that the usual stripelike magnetic phase, of orthorhombic symmetry, gives way to a second magnetic phase, of tetragonal symmetry, near the critical point, in the range from x = 0.24 to x=0.28 for Ba1-xKxFe2As2. In a prior study, an unidentified phase was discovered for x \u3c 0.24 but under applied pressure, whose onset was detected as a sharp anomaly in the resistivity. Here we report measurements of the electrical resistivity of Ba1-xKxFe2As2 under applied hydrostatic pressures up to 2.75 GPa, for x = 0.22, 0.24, and 0.28. The critical pressure above which the unidentified phase appears is seen to decrease with increasing x and vanish at x = 0.24, thereby linking the pressure-induced phase to the tetragonal magnetic phase observed at ambient pressure. In the temperature-concentration phase diagram of Ba1-xKxFe2As2, we find that pressure greatly expands the tetragonal magnetic phase, while the stripelike phase shrinks. This reveals that pressure may be a powerful tuning parameter with which to explore the interplay between magnetism and superconductivity in this material

Pediatric Procedural Pain

Reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures, and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs are discussed and recommendations provided. Pharmacological, other medical approaches, and empirically supported cognitive behavioral interventions are reviewed. Salient features of the interventions are discussed and recommendations are made for necessary components of effective treatment interventions

Fermi-surface reconstruction by stripe order in cuprate superconductors

Quantum oscillations have revealed the presence of a small pocket in the Fermi surface of the cuprate superconductor YBCO, whose nature and origin are the subject of much debate. Interpretations include electron and hole pockets; scenarios include Fermi-surface reconstruction by antiferromagnetism, d-density-wave order, and stripe order. Here we report quantum oscillations in the Seebeck and Nernst coefficients of YBCO and show, from the magnitude and sign of the Seebeck coefficient, that they come from an electron pocket. Using measurements of the Seebeck coefficient as a function of hole doping p, we show that the evolution of the Fermi surface in YBCO is the same as in Eu-LSCO, a cuprate where stripe order (a modulation of spin and charge densities) is well established. The electron pocket is most prominent where stripe order is strongest, at p = 1/8. This shows that Fermi-surface reconstruction is a generic mechanism of underdoped cuprates, intimately related to stripe order.Comment: 15 pages, 5 figures, Supplementary information now integrated into articl

Development and Implementation of a Registry of Patients Attending Multidisciplinary Pain Treatment Clinics: The Quebec Pain Registry

The Quebec Pain Registry (QPR) is a large research database of patients suffering from various chronic pain (CP) syndromes who were referred to one of five tertiary care centres in the province of Quebec (Canada). Patients were monitored using common demographics, identical clinical descriptors, and uniform validated outcomes. This paper describes the development, implementation, and research potential of the QPR. Between 2008 and 2013, 6902 patients were enrolled in the QPR, and data were collected prior to their first visit at the pain clinic and six months later. More than 90% of them (mean age ± SD: 52.76 ± 4.60, females: 59.1%) consented that their QPR data be used for research purposes. The results suggest that, compared to patients with serious chronic medical disorders, CP patients referred to tertiary care clinics are more severely impaired in multiple domains including emotional and physical functioning. The QPR is also a powerful and comprehensive tool for conducting research in a “real-world” context with 27 observational studies and satellite research projects which have been completed or are underway. It contains data on the clinical evolution of thousands of patients and provides the opportunity of answering important research questions on various aspects of CP (or specific pain syndromes) and its management