Pain location and widespread pain in youth with orthopaedic conditions: Exploration of the reliability and validity of a body map.

BACKGROUND: Pain location and widespread pain are important but underexamined dimensions of paediatric pain. Body map tools to assess pain location in youth have been used for several decades, but few studies have established reliability and validity of these measures. The purpose of this study was to explore the reliability and validity of a pain body map among youth with orthopaedic conditions before surgery. METHOD: Youth ages 10-17 years completed the body map and other self-reported outcomes at their preoperative clinic visit and at their day of surgery. RESULTS: Most (91.7%) youth had small discrepancy between body map scores at preoperative clinic visit (baseline) and day of surgery (second assessment), and site-to-site agreement ranged from 78% to 98%. Those with back and lower extremity diagnoses had high correspondence between body map sites and diagnostic sites. Body map scores and widespread pain were associated with other dimensions of pain, as well as other patient-reported outcomes. Higher pain intensity and widespread pain predicted greater discrepancy between body map scores. CONCLUSIONS: These results support the use of body map tools in further research examining widespread pain among youth by demonstrating adequate reliability, descriptive validity and associative validity. SIGNIFICANCE: These results contribute to the limited information regarding psychometric properties of paediatric pain body maps, provide novel information about widespread pain among youth undergoing orthopaedic surgeries, and pave the way for improved assessment and treatment of paediatric pain.

Conversion of polyhydroxyalkanoates to methyl crotonate using whole cells.

Isolated polyhydroxyalkanoates (PHA) can be used to produce biobased bulk chemicals. However, isolation is complex and costly. To circumvent this, whole cells containing PHA may be used. Here, PHA containing 3-hydroxybutyrate and small amounts of 3-hydroxyvalerate was produced from wastewater and used in the conversion of the 3-hydroxybutyrate monomer to methyl crotonate. Due to the increased complexity of whole cell reaction mixtures compared to pure PHA, the effect of 3-hydroxyvalerate content, magnesium salts and water content was studied in order to evaluate the need for downstream processing. A water content up to 20% and the presence of 3-hydroxyvalerate have no influence on the conversion of the 3-hydroxybutyrate to methyl crotonate. The presence of Mg(2+)-ions resulted either in an increased yield or in byproduct formation depending on the counter ion. Overall, it is possible to bypass a major part of the downstream processing of PHA for the production of biobased chemicals.

Cell-surface expression of L-selectin (CD62L) by blood lymphocytes: correlates with affective parameters and severity of panic disorder.

The surface immune phenotype of peripheral blood lymphocytes (PBL) was examined in 30 patients meeting DSM-III-R criteria for panic disorder and in 10 normal controls by immunostaining and cytofluorimetry. Patients with panic disorder and controls showed comparable numbers of PBL and no differences in the percentages of blood T-cells, B-cells, or NK-cells. The PBL in panic disorder patients showed a trend toward enrichment for "naive" CD45RA+ T-lymphocytes (35.0 +/- 7.6 vs. 28.7 +/- 9.8, P = 0.09) and significant enrichment for cells expressing CD62L (L-selectin, 22.9 +/- 5.9 vs. 14.6 +/- 6.3, P = 0.002), a lymphocyte homing receptor that mediates binding to lymph node endothelium. Increased expression of CD62L correlated directly with the global severity of illness, Hamilton Anxiety (HAM-A) and Hamilton Depression (HAM-D) scores. Although in the normal range, plasma cortisol levels were significantly increased in patients with panic disorder (P = 0.003) with respect to controls and correlated with the expression of CD62L by PBL. We conclude that the peripheral blood in panic disorder shows phenotypic changes that may reflect diminished cell activation in vivo.

Anxiety sensitivity in social phobia: comparison between social phobics with and without panic attacks.

The current study examines levels of anxiety sensitivity among social phobic patients with and without panic attacks. Two-hundred fourteen individuals with a primary diagnosis of social phobia completed the Anxiety Sensitivity Index (ASI) prior to treatment. Social phobics who experienced panic attacks reported higher levels of anxiety sensitivity than those without panic attacks. Patterning of response to ASI items differed between panicking and non-panicking patients, with the panicking patients reporting greater fear of catastrophic consequences of bodily sensations. Individuals with an additional diagnosis of panic disorder did not differ from those with exclusively situational panic attacks. The findings suggest the importance of examining differences between anxiety-disordered individuals who experience panic attacks and their non-panicking counterparts.

The anatomical distribution of skin cancers.

The relative density of skin tumours by anatomical site has been drawn from a variety of clinical studies and tumour registry investigations. The data sources are remarkably consistent and support current theories implicating chronic solar exposure in the development of non-melanoma and intense exposure for melanoma tumours.

Downwind and upwind effects in the Arizona cloud-seeding experiment.

The principal subject of this report is a comparison of precipitation on days with seeding with that without seeding, averaged over those rain gauges that on each particular day were "downwind," "upwind," or to the sides. Two estimates of relevant wind directions are used, based on successive radiosondes at Tucson that bracketed the scheduled time of seeding. By use of these radiosondes, the apparent effects of seeding on rain in downwind localities 90-180 miles (145-290 km) away from target were found to be an apparent 45% loss of rain (P = 0.002) and an apparent 34% loss of rain (P = 0.028), respectively. Other results indicate considerable geographic heterogeneity.

Re-evaluation of the Arizona cloud-seeding experiment.

The apparent effect of cloud seeding on the average 24-hr precipitation in the Santa Catalina Mountains during the two programs of the 7-year-long Arizona experiment was found to be a 30% loss of rain (P = 0.06). Considering rainy days only, the apparent effect is a 34% loss of rain (P = 0.03). On South-East days the apparent loss was 40% (P = 0.03). The analysis of the diurnal variation in the amounts of hourly precipitation brought out two suggestions: (i) more active silver iodide enters the clouds through seeding at their bases than at the -6 degrees C level; (ii) the population of experimental days includes two categories with opposite responses to seeding: augmentations of rain in one case and losses in the other. These suggestions require independent confirmation.

Hypothetical explanations of the negative apparent effects of cloud seeding in the whitetop experiment.

In order to explain the apparent losses of rain ascribable to seeding at the Whitetop trial, particularly large and highly significant in the stratum E (but not in the opposite stratum W) of experimental days, it has been hypothesized that seeding causes widespread cloudiness and subsequent lowering of ground temperatures. This hypothesis is flatly contradicted by the observations: the seeded E-days (but not W-days) were uniformly less cloudy and hotter than those without seeding. Curiously, these differences prevailed not only from the scheduled time of seeding but also for several hours beforehand. The average rainfall for the 10 hr that preceded the time of seeding was investigated in eight "cells", defined by the day's wind direction to be downwind, upwind, and to the sides and "far" and "near" the center of seeding. Highly significant decreases were found in the far-upwind and far-left cells, indicating an earlymorning disparity between those E-days that later were declared as experimental to be seeded and those E-days that were declared as experimental not to be seeded. This disparity, difficult to explain by chance variation, suggests that particular caution be used in treating differences in the rainfall between seeded and not-seeded days in the Whitetop trial as having been caused by seeding.

Further studies of the whitetop cloud-seeding experiment.

By means of two stratifications of experimental days of the Whitetop Project-into categories E and W and into categories air mass and frontal-the effects of cloud seeding on precipitation downwind, upwind, and to the sides, up to 180 miles from the seeding line, were investigated. No significant effects were found for W and frontal days. On the other hand, for E and airmass days, significant and highly significant apparent effects of seeding were found in all directions and in areas at distances up to 180 miles. All these significant apparent effects are negative, the largest of them indicating that seeding reduced precipitation to one quarter of its unseeded value.