Evolution and divergence of the genetic lineage Desmodus rotundus/Artibeus lituratus of rabies virus in São Paulo State.

The last record of a rabies case caused by the dog-specific rabies virus (RABV) lineage in dogs or cats in São Paulo State was in 1998. From 2002 to 2021, 57 cases of rabies in these animals were reported, and the vast majority (51) were genetically characterized as belonging to the Desmodus rotundus/Artibeus lituratus RABV lineage. However, it is not currently possible to infer which of these bats is the source of infection by genome sequencing of RABV isolates. The aims of this study were (a) to characterize the Desmodus rotundus/Artibeus lituratus lineage to determine the relationships between the RABV lineages and each reservoir, (b) to assess the phylogeny and common ancestors of the RABV lineages found in D. rotundus and A. lituratus, and (c) to further understand the epidemiology and control of rabies. In this study, we genetically analyzed 70 RABV isolates from São Paulo State that were received by the Virology Laboratory of the Pasteur Institute of São Paulo between 2006 and 2015. Of these isolates, 33 were associated with the hematophagous bat D. rotundus and 37 with the fruit bat A. lituratus. A genomic approach using phylogenetic analysis and nucleotide sequence comparisons demonstrated that these isolates belonged to the same genetic lineage of RABV. We also found that, in São Paulo State, the D. rotundus/A. lituratus lineage could be subdivided into at least four phylogenetic sublineages: two associated with D. rotundus and two with A. lituratus. These results are of importance for the epidemiological surveillance of rabies in São Paulo.

Heat stress of gilts around farrowing causes oxygen insufficiency in the umbilical cord and reduces piglet survival.

Late gestating sows are susceptible to high ambient temperatures, possibly causing farrowing complications and reducing piglet survival. This experiment aimed to quantify in the days leading up to farrowing the impact of sow heat stress (HS) on farrowing physiology and survival of the piglets. Pregnant primiparous sows (gilts) were allocated to either thermoneutral control (CON, n = 8; constant 20 °C) or cyclical HS conditions (n = 8; 0900 h to 1700 h, 30 °C; 1700 h to 0900 h, 28 °C) from d 110 of gestation until farrowing completion. Gilt respiration rate, skin temperature and rectal temperature were recorded daily, and farrowing duration was quantified by video analyses. Blood samples were collected from the piglet umbilical vein at birth. At 48 h of age, piglet growth was quantified by morphometric analyses. The thermal exposure model induced HS and respiratory alkalosis in the gilts, as indicated by increased respiration rate, rectal temperature, skin temperature (all P < 0.001), plasma cortisol (P = 0.01) and blood pH (P < 0.001). Heat-stressed gilts took longer to start expelling placentae (P = 0.003), although the active farrowing duration was not significantly different between treatments. Stillbirth rates were higher in the HS group (P < 0.001), with surviving piglets at birth having lower umbilical vein partial pressure of oxygen (P = 0.04), oxygen saturation rate (P = 0.03) and tending to have increased lactate concentrations (P = 0.07). At birth, piglet skin meconium staining scores were greater in the HS group (P = 0.022). At 48 h of age, piglets from the HS group had reduced small intestinal length (P = 0.02), reduced jejunal crypt depth (P = 0.02) and lighter absolute brain weight (P = 0.001). In contrast, piglet BW, growth rate, relative organ weight and small intestinal mucosal barrier function did not change between treatments. Collectively, these findings demonstrated gilt HS during late gestation caused farrowing complications and reduced the umbilical oxygen supply to the piglets at parturition, leading to increased risks of piglet stillbirth with implications on impaired neonatal survivability and development.

A comparative study of direct fluorescent antibody, mouse inoculation, and tissue culture infection testing for rabies diagnoses.

The laboratory diagnosis of rabies is of fundamental importance to the evaluation of suspected cases of rabies virus (RABV) infection. Confirmation of direct fluorescent antibody test (DFAT) results via viral isolation (VI) is recommended, and the mouse inoculation test (MIT) is being replaced by the rabies tissue culture infection (RTCIT) test for ethical reasons. We evaluated 6.514 results from central nervous system (CNS) samples of different animals analyzed at the Pasteur Institute between 2008 and 2016 using the DFAT, RTCIT and MIT techniques and evaluated their concordance, sensitivity, specificity, and accuracy indices. The DFAT technique presented the best sensitivity (93.58 %), specificity (95.90 %), and accuracy (95.67 %) results. The RTCIT values of sensitivity, specificity and accuracy (70.42 %, 86.16 % and 84.62 % respectively) were lower than those of DFAT. The concordance between RTCIT and DFAT was moderate, with a kappa quotient k = 0.341. The MIT values of sensitivity, specificity, and accuracy were 89.58 %, 100 % and 98.97 % respectively. The concordance between MIT and DFAT was substantial, with a k value of 0.720. DFAT, considered the "gold standard", was effective in all animals except horses. Our analyses evidenced that DFAT presents satisfactory results, although RTCIT did not appear favorable as a confirmatory technique.

Use of bioelectrical impedance spectroscopy to provide a measure of body composition in sows.

The ability to accurately estimate fat mass and fat-free mass (FFM) has the potential to improve the way in which sow body condition can be managed in a breeding herd. Bioelectrical impedance spectroscopy (BIS) has been evaluated as a practical technique for assessment of body composition in several livestock species, but similar work is lacking in sows. Bioelectrical impedance uses population-specific algorithms that require values for the apparent resistivities of body fluids and body proportion factors. This study comprised three major aims: (i) to derive apparent resistivity coefficients for extracellular water (ECW) and intracellular water (ICW) required for validation of BIS predictions of total body water (TBW) in live sows against standard reference tracer dilution methods; (ii) to develop predictions of TBW to body composition prediction algorithms, namely FFM, by developing a body geometry correction factor (Kb) and (iii) to compare the BIS predictions of FFM against existing impedance predictors and published prediction equations for use in sows, based on physical measurements of back-fat depth and BW (P2-based predictors). Whole body impedance measurements and the determination of TBW by deuterium dilution and ECW by bromide dilution were performed on 40 Large White x Landrace sows. Mean apparent resistivity coefficients of body fluids were 431.1 Ω.cm for ECW and 1827.8 Ω.cm for ICW. Using these coefficients, TBW and ECW were over-estimated by 6.5 and 3.3%, respectively, compared to measured reference values, although these differences were not statistically different (P > 0.05). Mean Kb was 1.09 ±â€¯0.14. Fat-free mass predictions were 194.9 kg, which equates to 60.9% of total sow weight, and 183.0 kg for BIS and the deuterium dilution method, respectively. Mean differences between the predicted and measured FFM values ranged from -8.2 to 32.7%, but were not statistically different (P > 0.05). Method validation (leave-one-out procedure) revealed that mean differences between predicted and measured values were not statistically significant (P > 0.05). Of the impedance-based predictors, equivalence testing revealed that BIS displayed the lowest test bias of 11.9 kg (8.2%), although the P2-based prediction equations exhibited the lowest bias and percentage equivalence, with narrow limits of agreement. Results indicate although differences between mean predicted and measured values were not significantly different, relatively wide limits of agreement suggest BIS as an impractical option for assessing body composition in individual sows compared to the use of existing prediction equations based on BW and back fat.

Electrical stimulation or moisture infusion improves the eating quality attributes of loin and silverside cuts from female and immunocastrated male pigs.

This study validated the effect of gender (female, immunocastrated male; n = 50), electrical stimulation (none or 150 mA constant current for 30 s at 2 min post-slaughter) and ageing period (2 or 14 d) on the eating quality of pork roast and stir fry sourced from the loin (M. longissimus thoracis et lumborum) and silverside (M. biceps femoris) and steak from the loin only. Moisture infusion was applied to 2 d aged, non-stimulated primals as a positive control treatment. Neither gender nor ageing period influenced (P > 0.05) eating quality. Electrical stimulation and moisture infusion were each effective interventions in improving pork eating quality, but their effects were inconsistent between the five cuts evaluated. No interventions achieved the fail rate target of <10% for quality grade for all cuts, indicating that additional interventions are needed to enable industry to consistently deliver high quality pork.

Guaranteeing the quality and integrity of pork - An Australian case study.

The Australian pork industry is strongly committed to assuring the integrity of its product, with substantial research investment made over the past ten years to develop and implement systems to assure the consistency and quality of fresh pork and to enable accurate tracing of unpackaged fresh pork back to property of origin using trace elemental profiling. These initiatives are pivotal to allow Australian pork of guaranteed eating quality to be successfully positioned as higher value products, across a range of international and domestic markets, whilst managing any threats of product substitution. This paper describes the current status of the development of a predictive eating quality model for Australian pork, utilizing eating quality datasets generated from recent Australian studies. The implementation of trace elemental profiling, by Physi-Trace™, to verify and defend provenance claims and support the supply of consistently high eating quality Australian pork to its customers, is also discussed.

Validating post-slaughter interventions to produce consistently high quality pork cuts from female and immunocastrated male pigs.

Eating quality attributes of pork loin (M. longissimus thoracis et lumborum) and silverside (M. biceps femoris) from female and immunocastrated male carcases hung from either the Achilles tendon or aitchbone, aged for either 2 or 7 days post-slaughter and cooked as roasts, stir fry and steak (loin only) (n = 25/gender) was assessed. A positive control treatment of moisture infusion (10% injection rate) was applied to Achilles hung sides with cuts aged for 2 d post-slaughter. Neither gender nor ageing period influenced consumer sensory scores. Beneficial effects of aitchbone hanging on eating quality compared with Achilles hanging were largely observed after 2 d ageing, with improvements (P < 0.05) in overall liking scores found for loin stir fry and silverside stir fry and roasts. Overall liking scores of all cuts, except silverside stir fry, were increased (P < 0.05) when moisture infused compared with those from aitchbone-hung sides. However, targeted fail rates of <10% were not consistently achieved across all cuts evaluated.

Eating quality traits of shoulder roast and stir fry cuts outperformed loin and silverside cuts sourced from entire and immunocastrated male pigs.

This study investigated the effects of ageing period (2 or 7days), endpoint temperature (70 or 75°C), cut type (loin (M. longissimus thoracis et lumborum), silverside (M. biceps femoris), blade (M. triceps brachii) and chuck tender (M. supraspinatus)), cooking method (roast and stir fry (all cuts) and steak (loin only)) on eating quality attributes of pork from entire and immunocastrated male pigs. Higher intramuscular fat levels were found in all cuts from immunocastrated males compared with entire males. Of the seven cut type×cooking method combinations evaluated, shoulder cuts had the lowest fail rate (P<0.001) and loin steak and silverside cuts scored lowest (P<0.001) for tenderness, juiciness, overall liking, quality grade and re-purchase intention. Although no differences in sensory scores due to gender were observed, boar taint was identified in 10% of entire males. Minimising adverse risks in eating quality due to boar taint in males remains a key industry issue to ensure consistent delivery of high quality pork.

Diet composition and slaughter age up to 24weeks have minimal impact on pork eating quality of loin steaks and silverside roasts from female pigs.

Female crossbred pigs were randomly allocated at 16weeks of age to one of three dietary treatments (A: corn and soybean meal; B: wheat and canola meal; C: wheat and sorghum) matched for digestible energy (13.6MJ DE/kg) and total lysine (0.93-0.95%) and fed for 4, 5 or 8weeks, respectively, prior to slaughter. Loin (M. longissimus thoracis et lumborum) and silverside (M. biceps femoris) were obtained from 20 pigs per dietary treatment group and prepared into steaks and roasts, respectively, for consumer evaluation with ageing treatments of 7 and 28days post-slaughter allocated within muscle. Neither dietary treatment/age at slaughter nor ageing treatment influenced sensory traits of either cut. Intramuscular fat levels were also not influenced by dietary treatment. Higher (P<0.001) fail rates for silverside roasts compared with loin steaks indicate that different interventions are needed at a cut level to optimise pork eating quality consistency and consumer expectations.

Quantifying production, processing and post-slaughter effects on pork eating quality using random effects meta-regression.

Random effects meta-regression techniques, analyzed using a restricted maximum likelihood (REML) approach, was used to determine the influence of various factors that may be experienced or imposed on pigs, carcases and pork on pork eating quality attributes and shear force of the M. longissimus dorsi (loin). This was done to inform the development of a pathway based eating quality system for pork. Estimated means of explanatory variables were obtained for those pathway factors where sufficient published studies met the criteria for inclusion in the analysis. Due to a lack of data for interactions between factors investigated, only single factors were included as fixed terms in the REML models. This analysis identified that moisture infusion (P < 0.001), ageing for more than 2 d post-slaughter (P = 0.006) and tenderstretching (P = 0.006) each resulted in significant improvements in tenderness. Cooking loins to an endpoint temperature of ≥ 80°C negatively impacted both tenderness (P = 0.022) and juiciness (P < 0.001) scores compared with 70 to 74°C. It was not possible to develop algorithms to reliably estimate the effects of multiple factors on pork eating quality attributes to a cuts-based level due to limited studies reporting data for treatment interactions.

The Epidemiological Importance of Bats in the Transmission of Rabies to Dogs and Cats in the State of São Paulo, Brazil, Between 2005 and 2014.

In Brazil, rabies control in dogs and cats was pioneered by the state of São Paulo with the adoption of the Pan American Health Organization recommendations for prophylaxis and control, which led to a reduction in rabies cases from 1994 onwards. As a result of these measures, the rabies virus (RABV) genetic lineage associated with dogs has not been found in the state since 1998, and all the cases in domestic animals reported since then have been caused by bat-associated lineages of RABV. In the light of this, this study sought to investigate rabies cases in dogs and cats in the state of São Paulo between 2005 and 2014 and identify the associated transmission cycles by characterizing the RABV lineages responsible for these cases. Nine samples from dogs (n = 5) and from cats (n = 4) were collected between 2005 and 2014. The tenth animal, a rabid cat, was analysed by a different laboratory. The N gene nucleotide sequences obtained were analysed with the neighbor-joining algorithm and Kimura 2-parameter model using the MEGA 6 program. Phylogenetic analysis revealed that the genetic lineages identified in all the samples were those circulating in Brazilian bats. The findings of this study demonstrate that bats play an important role in the transmission of rabies to domestic animals in São Paulo state and that emphasis should be placed on the implementation of public policies to support surveillance of chiropterans for rabies.

Developing a cuts-based system to improve consumer acceptability of pork: Impact of gender, ageing period, endpoint temperature and cooking method.

The effect of gender (entire male, female and castrate), ageing period (2 or 7days) and endpoint temperature (70 or 75°C) on consumer perceptions of cuts from the loin (Musculuslongissimus thoracis et lumborum), silverside (Musculus biceps femoris) and shoulder (Musculus triceps brachii (roast) and Musculus supraspinatus (stir fry)) when roasted or stir fried (all primals) or grilled as steaks (loin only) was investigated. Higher scores for juiciness (P=0.035), flavour (P=0.017), overall liking (P=0.018), quality grade (P=0.026) were obtained from castrates than entire males, with females intermediate. Neither ageing period nor endpoint temperature, as main effects, influenced sensory scores. Loin steaks and silverside roasts obtained lower (P<0.001) scores for all sensory traits except aroma; scores for shoulder cuts were highest (P<0.001). Cooking to 70°C improved (P<0.05) juiciness, flavor and overall liking scores of loin steaks compared with 75°C. Different pathway interventions are required to optimize eating quality of different pork cuts and the cooking methods used to prepare them.

Estimating the impact of various pathway parameters on tenderness, flavour and juiciness of pork using Monte Carlo simulation methods.

Monte Carlo simulation was investigated as a potential methodology to estimate sensory tenderness, flavour and juiciness scores of pork following the implementation of key pathway interventions known to influence eating quality. Correction factors were established using mean data from published studies investigating key production, processing and cooking parameters. Probability distributions of correction factors were developed for single pathway parameters only, due to lack of interaction data. Except for moisture infusion, ageing period, aitchbone hanging and cooking pork to an internal temperature of >74°C, only small shifts in the mean of the probability distributions of correction factors were observed for the majority of pathway parameters investigated in this study. Output distributions of sensory scores, generated from Monte Carlo simulations of input distributions of correction factors and for individual pigs, indicated that this methodology may be useful in estimating both the shift and variability in pork eating traits when different pathway interventions are applied.

Lithium Induces Glycogen Accumulation in Salivary Glands of the Rat.

Lithium is administered for the treatment of mood and bipolar disorder. The aim of this study was to verify whether treatment with different concentrations of lithium may affect the glycogen metabolism in the salivary glands of the rats when compared with the liver. Mobilization of glycogen in salivary glands is important for the process of secretion. Two sets of experiments were carried out, that is, in the first, the rats received drinking water supplemented with LiCl (38,25 and 12 mM of LiCl for 15 days) and the second experiment was carried out by intraperitoneal injection of LiCl solution (12 mg/kg and 45 mg LiCl/kg body weight) for 3 days. The active form of glycogen phosphorylase was not affected by treatment with LiCl considering the two experiments. The active form of glycogen synthase presented higher activity in the submandibular glands of rats treated with 25 and 38 mM LiCl and in the liver, with 25 mM LiCl. Glycogen level was higher than that of control in the submandibular glands of rats receiving 38 and 12 mM LiCl, in the parotid of rats receiving 25 and 38 mM, and in the liver of rats receiving 12 mM LiCl. The absolute value of glycogen for the submandibular treated with 25 mM LiCl, and the liver treated with 38 mM LiCl, was higher than the control value, although not statistically significant for these tissues. No statistically significant difference was found in the submandibular and parotid salivary glands for protein concentration when comparing experimental and control groups. We concluded that LiCl administered to rats influences the metabolism of glycogen in salivary glands.

Anthropomorphic phantom to investigate the bladder dose in gynecological high-dose-rate brachytherapy.

PURPOSE: This study presents a prototype of a phantom appropriate for experimental bladder dosimetry. This work presents details of the phantom construction and dosimetric results obtained using radiochromic film and optically stimulated luminescence dosimeters (OSLDs). METHODS AND MATERIALS: The phantom was constructed of polymethyl methacrylate. Two artificial bladders were three-dimensional printed using previous computed tomography images. Radiochromic films and OSLDs were positioned on the artificial bladder walls, and the applicators were placed according to the original computed tomography image. RESULTS: The prototype phantom simulated the behavior of the dose on the bladder surface, enabling bladder movement in all directions. The dosimetric study that was performed using radiochromic film and OSLDs exhibited concordance, in most cases, with the results obtained from the planning system. CONCLUSIONS: The methodology presented offers conditions for researchers to investigate more accurately the behavior of the dose on the bladder surface during intracavitary brachytherapy procedures.

Ion release and mechanical properties of calcium silicate and calcium hydroxide materials used for pulp capping.

AIM: To compare the ion release and mechanical properties of a calcium hydroxide (Dycal) and two calcium silicate (MTA Angelus and Biodentine) cements. METHODOLOGY: Calcium and hydroxyl ion release in water from 24-h set cements were calculated from titration with HCl (n = 3). Calcium release after 7, 14, 21 and 28 days at pH 5.5 and 7.0 was measured using ICP-OES (n = 6). Flexural strength (FS) and modulus (E) were tested after 48-h storage, and compressive strength (CS) was tested after 48 h and 7 days (n = 10). Ion release and mechanical data were subjected to anova/Tukey and Kruskal-Wallis/Mann-Whitney tests, respectively (α = 0.05). RESULTS: Titration curves revealed that Dycal released significantly fewer ions in solution than calcium silicates (P < 0.001). Calcium release remained constant at pH 7.0, whilst at pH 5.5, it dropped significantly by 24% after 21 days (P < 0.05). At pH 5.5, MTA Angelus released significantly more calcium than Dycal (P < 0.01), whilst Biodentine had superior ion release than Dycal at pH 7.0 (P < 0.01). Biodentine had superior flexural strength, flexural modulus and compressive strength than the other cements, whilst MTA Angelus had higher modulus than Dycal (P < 0.001). CONCLUSIONS: Immediate calcium and hydroxyl ion release in solution was significantly lower for Dycal. In general, all materials released constant calcium levels over 28 days, but release from Dycal was significantly lower than Biodentine and MTA Angelus depending on pH conditions. Biodentine had substantially higher strength and modulus than MTA Angelus and Dycal, both of which demonstrated low stress-bearing capabilities.

Aitchbone hanging and ageing period are additive factors influencing pork eating quality.

The effects of abattoir, carcase weight (60 or 80 kg HCW), hanging method (Achilles or aitchbone) and ageing period (2 or 7 day post-slaughter) on eating quality attributes of pork were investigated in this 3×2×2×2 factorial study. A total of 144 Large White×Landrace female pigs were slaughtered at one of three abattoirs and sides hung from either the Achilles tendon or the aitchbone. After 24 h chilling, loin (M. longissimus thoracis et lumborum) and topside (M. semimembranosus) muscles were individually vacuum packaged and aged for 2 or 7 days post-slaughter. Consumers (n=852) evaluated eating quality. Neither abattoir nor carcase weight influenced tenderness, flavour or overall liking of pork. Improvements in tenderness, flavour and overall liking were found due to aitchbone hanging (P<0.001) and ageing (P<0.001) for 7 days compared with Achilles-hung carcases and pork aged for 2 days, respectively. This study demonstrated that aitchbone hanging and 7 day ageing can improve eating quality, but these effects were additive as the interaction term was not significant.

Dietary lecithin improves dressing percentage and decreases chewiness in the longissimus muscle in finisher gilts.

The influence of dietary lecithin at doses of 0, 4, 20 or 80 g/kg fed to finisher gilts for six weeks prior to slaughter on growth performance, carcass quality and pork quality was investigated. M. longissimus lumborum (loin) was removed from 36 pig carcasses at 24h post-mortem for Warner-Bratzler shear force, compression, collagen content and colour analyses. Dietary lecithin increased dressing percentage (P=0.009). Pork chewiness and collagen content were decreased by dietary lecithin (P<0.05, respectively), suggesting that improved chewiness may be due to decreased collagen content. However, dietary lecithin had no effect on shear force, cohesiveness or hardness (P>0.05, respectively). Dietary lecithin reduced loin muscle L* values and increased a* values (P<0.05, respectively) but no changes on b* values (P=0.56). The data showed that dietary lecithin improved dressing percentage and resulted in less chewy and less pale pork.

TL behavior of topaz-glass composite in various irradiation fields.

Topaz is a natural hard silicate mineral that has the potential to be used as a thermoluminescent dosimeter (TLD). It is difficult to manufacture chips of topaz and problematic to use its powder as TLDs. Topaz-glass composite (in the form of pellets) can be made easily and applied for radiation dosimetry. To produce pellets of topaz-glass composite in 2:1 wt (%), topaz powder was combined with commercial glass. The pellets with 6 mm diameter and 1 mm thickness were sintered in a furnace at 900°C for 1 h. The composite pellets were irradiated with x-ray and gamma photons and alpha and beta particles. The pellets yielded two peaks in the glow curve; Peak 1 at temperature range 150-160°C and Peak 2 at 250-260°C. The intensity of Peak 2 rose linearly with the increase in absorbed dose. The intensity of Peak 2 was comparable with peaks for photons and beta irradiation but relatively low for alpha exposure. The reproducibility of the intensity of Peak 2 was within 5-8%. Two months after irradiation of the pellets, the fading of the intensity of Peak 2 was found to be about 7%. The topaz-glass composite can be used effectively and efficiently for dosimetry of alpha, beta, and gamma radiation.

Responsiveness of the Intermittent and Constant Osteoarthritis Pain (ICOAP) scale in a trial of duloxetine for treatment of osteoarthritis knee pain.

OBJECTIVE: To assess the change in the Intermittent and Constant Osteoarthritis Pain (ICOAP)-scale scores in patients taking duloxetine or placebo and to characterize the responsiveness of the ICOAP by comparing the effect size associated with its scales to effect sizes seen with other pain scales used in this study. METHODS: This was a secondary analysis of data from a 10-week, double-blind, randomized, flexible-dose, placebo-controlled trial that enrolled patients who had persistent moderate pain due to osteoarthritis (OA) of the knee, despite having received nonsteroidal anti-inflammatory drug (NSAID) therapy. The pain measures used in this study (focusing on the drug-placebo difference at week 8) were patient-rated pain severity, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Brief Pain Inventory (BPI), and the ICOAP. RESULTS: The mean difference between duloxetine and placebo at week 8 for patient-rated pain severity, the BPI average pain, WOMAC pain, and each ICOAP scale was statistically significant (P < 0.001 for each). The ICOAP total showed a moderate effect size of 0.53, whereas the constant and intermittent scores showed effect sizes of 0.47 and 0.49, respectively. The patient-rated pain severity and the BPI average pain showed similar moderate effect sizes of 0.59 and 0.53, respectively. CONCLUSION: The study demonstrated efficacy of duloxetine compared with placebo when using the ICOAP scale in a placebo-controlled trial. The observed treatment effect size for the ICOAP scores was similar to that for other reliable, valid and responsive pain assessments. CLINICAL TRIALS REGISTRATION: ClinicalTrial.gov Identifier: NCT01018680.