Soil phosphorus variability in pastures: implications for sampling and environmental management strategies.

Soil phosphorus (P) is an increasingly important consideration in the development of P-based nutrient management strategies. The objectives of this study were to (i) obtain baseline information on soil P variability in pastures amended with animal waste, (ii) examine if current sampling recommendations related to the number of subsamples adequately reduce uncertainty to acceptable limits, and (iii) examine the implications of uncertainty in soil P estimates on implementing a soil P threshold of 150 mg kg(-1). Grid soil samples were collected from 12 pastures. Soil P was determined using Mehlich 3 extractant and an inductively coupled argon plasma spectrometer. The arithmetic mean of soil P ranged from 7 mg kg(-1) in a pasture never amended with animal manure to 437 mg kg(-1) in a pasture that had been annually treated long term with poultry litter. Variance of soil P generally increased with mean soil P. The mean standard deviation of all pastures was one-third of the 150 mg kg(-1) threshold. This study points out that smaller variances associated with mean soil P values that approach, but do not exceed, the threshold can influence estimates of soil P. In turn, management decisions could inappropriately change. When a uniform acceptance criteria (within 15 mg kg(-1)) with respect to measured means was used, the required minimum number of subsamples increased with measured standard deviation. The results of this study imply that following soil-sampling recommendations is critical to obtaining trustworthy measures of central tendency, especially in pastures approaching but not exceeding the 150 mg kg(-1) threshold.

Perceived treatment helpfulness and cost in chronic pain rehabilitation.

OBJECTIVE: This article examines the perceived helpfulness of treatment components in comprehensive interdisciplinary pain management programs as they relate to cost. DESIGN: Patient satisfaction results assessed by the Treatment Helpfulness Questionnaire (THQ) and treatment costs were compared for 309 subjects at three comprehensive interdisciplinary chronic pain management centers. All subjects completed the THQ immediately after treatment, and follow-up data were gathered 3 to 6 months after the end of treatment at two of the three centers. RESULTS: Ratings of treatment helpfulness were not found to be related to either demographic or medical variables. Mean THQ ratings for many treatment modalities did differ significantly between centers, but subjects at all centers generally gave higher THQ ratings to psychological and educational therapies than to physical therapy and medical modalities both at posttreatment and at follow-up evaluations. More costly treatments generally did not receive higher ratings than less costly ones. THQ ratings tended to decline modestly from posttreatment to follow-up evaluations. CONCLUSIONS: For the selected population of patients undergoing comprehensive interdisciplinary pain management, educational and psychological approaches received high ratings of helpfulness at a relatively low cost. Further research is needed to address whether comparative patient satisfaction data can be used at pain centers to produce improved outcomes at reduced costs.

Treatment Helpfulness Questionnaire: a measure of patient satisfaction with treatment modalities provided in chronic pain management programs.

The Treatment Helpfulness Questionnaire (THQ) is presented as a reliable and valid measure for assessing patient perceptions of the helpfulness of treatment modalities offered at multidisciplinary pain centers. It is easy to administer and score and shows good interscorer and test-retest reliability without order effects and with good internal consistency. Patients give diverse responses to items that fall into four factors, three of which represent identifiable components of multidisciplinary treatment for chronic pain. Findings that similar THQ items are positively correlated and that many items show positive correlations with treatment outcome support the validity of the instrument. The latter finding also suggests the potential of patient satisfaction measurement for improving treatment outcomes at pain centers.

Soil and solid poultry waste nutrient management and water quality.

Concerns about the impacts of nitrogen, phosphorus, and pathogens on surface and ground water quality has forced the poultry industry to implement voluntary waste management guidelines for use by growers. In some states, animal waste guidelines are being enforced by regulatory agencies. Strategies that growers may use to properly dispose of poultry waste include: 1) local land application as a fertilizer; 2) offsite marketing for use as a fertilizer or soil amendment, feed additive, or energy source; and 3) chemical additives that will immobilize nitrogen and phosphorus in the manure or litter. If properly followed, these and other innovative strategies should be adequate to protect surface and ground water quality without adversely affecting the economics of poultry production.

Prediction of treatment outcome from clinically derived MMPI clusters in rehabilitation for chronic low back pain.

OBJECTIVE: The aim of this study was to assess the ability of specific and clinically relevant Minnesota Multiphasic Personality Inventory (MMPI) profile types to predict outcomes in a structured interdisciplinary pain-management program for patients with low back pain. DESIGN: Subjects were divided into clusters representing MMPI profiles yielding similar clinical interpretation. Analyses of variance and chi-square testing assessed the effect of cluster group on a variety of outcome measures at pretreatment, posttreatment, and 6- to 66-month follow-up. Fisher's Least Significant Difference Test assessed the significance of differences between pairs of cluster groups. SETTING: A university-based comprehensive interdisciplinary pain-management program serving both inpatients and outpatients. PATIENTS: 122 subjects with chronic low back pain who completed the program, provided follow-up data, and fit into the definition of one of seven clusters. MAJOR OUTCOME MEASURES: Self-reports of subjective pain intensity, pain-related medication intake, and activity level at pretreatment, posttreatment, and follow-up; employment status at pretreatment and follow-up. RESULTS: Cluster groups did not differ significantly at any time on activity level and medication intake and differed on employment status only at pretreatment. There was a significant (p < 0.05) effect of cluster group on subjective pain intensity, but only two pairwise group comparisons were significant: subjects with a normal MMPI profile and those with no elevations except T = 71-80 on Hypochondriasis and Hysteria reported less pain at follow-up than did subjects with extreme elevations (T > 80) on both Hypochondriasis and Hysteria. CONCLUSION: Even when subjects with chronic pain are divided into cluster groups associated with highly similar clinical interpretations, the MMPI for the most part fails to predict self-reported outcomes in an interdisciplinary pain-management program.

Patterns of conscious failure to provide accurate self-report data in patients with low back pain.

Assessment and treatment responses were compared in 17 subjects with chronic low back pain assessed as showing at least one clear consciously produced inconsistency in statements and/or behaviors during their participation in an interdisciplinary treatment program and 143 subjects assessed as showing no such inconsistency. Numerous statistically significant differences emerged: Inconsistent subjects were more likely to have pending litigation and to be assessed by staff as showing a higher degree of focus on pain and more dramatized complaints, lower levels of medical findings and attention and interest in treatment, and poor compliance with treatment and assessment procedures. In addition, these subjects reported lower levels of physical activity and generally more inconsistent or negative responses to lumbar sympathetic injections with fewer expected changes in physical sensations. Though not definitive, these results suggested a syndrome of characteristics among such subjects which are similar to those proposed as likely characterizing malingerers. The need for a particularly careful validation of self-report data in patients showing many of these characteristics was emphasized.

Chronic pain as a learned experience: Emory University Pain Control Center.

Chronic pain is often a conditioned socioeconomic disease. A majority of chronic pain patients show pain behavior in excess of biomedical findings and disability ratings out of proportion to their actual physical impairment. Biomedical data and pain behavior are independent variables, as the latter is heavily controlled by socioeconomic factors. The diagnosis of chronic pain patients requires evaluation and matching of both variables. When disability claims are present, a comprehensive vocational evaluation should be performed and matched with biomedical and behavioral findings. The Emory Pain Estimate Model for diagnosis of chronic pain states is discussed briefly and techniques of vocational evaluation are presented also. The structure of the Emory Pain Control Program and data from treatment outcome are presented and discussed.

The "learned pain syndrome": decoding a patient's pain signals.

Learned pain is a distinct entity with its own set of symptoms, diagnostic criteria, and treatment methods. Recognition of the condition by health professionals is necessary for proper patient management and will facilitate further research and appropriate training.

Maturation of normal human epidermis without an ordered structure.

Whole mounts of epidermis were prepared from hamster and mouse ears and from three sites on six normal human volunteers. Corneocyte columns were sought visually with the light microscope and statistically with cluster analysis applied to the surface distribution of superficial nucleated keratinocytes. In fifteen consecutive fields of hamster and mouse epidermis, both cell columns and clustering of nuclei were detected. In eighteen consecutive biopsies from the forearm, back and thigh of six normal adult men, stacking was never seen and clustering could not be demonstrated statistically. Corneocyte columns do occur regularly in some mammalian species and they have been reported to occur in human skin, but such columns are not common in these sites from normal human skin.

Chronic pain states: their relationship to impairment and disability.

Chronic pain patients (101) were assigned ratings of impairment and disability and were assessed for organic pathology and pain behavior through comprehensive testing procedures. As predicted, higher ratings of impairment and disability were significantly associated with higher levels of both physical pathology and pain behaviors. These results indicate that conditioning and pathologic processes significantly influence impairment and disability ratings. Many patients showed higher disability than impairment ratings, which suggests the possibility of gainful employment in less demanding jobs. However, the current disability system rewards sickness and dysfunction and discourages patients from resuming work.