Central sensitization, chronic pain, and other symptoms: Better understanding, better management.

Central sensitization, a pathophysiologic process in which the central nervous system undergoes changes that alter its processing of pain and other sensory stimuli, may be the mechanism underlying various conditions in which patients have unexplained pain and fatigue. Patients frequently misunderstand the cause of their symptoms and pursue unnecessary evaluations and treatments. Clinicians have a pivotal role in decreasing this misunderstanding by providing patient education, which can affect perception, management, functional status, and quality of life.

Hypervigilance and depression as predictors of eye tracking to ambiguous pictures in trauma survivors.

Hypervigilance, attentional bias, and negative views of the world play a significant role in post trauma symptomatology and can be associated with both clinical depression and posttraumatic stress. However, both theory and research suggest there may be discernible differences in attentional patterns between these two outcomes. While depression may be associated with a general negativity bias, posttraumatic stress may be specifically associated with visual scanning, hypervigilance, and threat detection.

Retrospective Analysis of Thromboelastography-Directed Transfusion in Isolated CABG: Impact on Blood Product Use, Cost, and Outcomes.

Cardiac surgeries account for approximately 20% of blood use in the United States. Allogeneic transfusion has been associated with increased risk of morbidity and mortality, further justifying the need to reduce blood use. This study aimed at determining whether a point-of-care coagulation test, thromboelastography (TEG), impacted blood product administration and outcomes.

Extremes of body mass index have significant impact on complications, readmissions, and utilization of post-acute services after primary total hip arthroplasty.

Aims: High body mass index (BMI) is associated with increased rates of complications in primary total hip arthroplasty (THA), but less is known about its impact on cost. The effects of low BMI on outcomes and cost are less understood. This study evaluated the relationship between BMI, inpatient costs, complications, readmissions, and utilization of post-acute services.

Simulating synergies between Climate Change Adaptation and Disaster Risk Reduction stakeholders to improve management of transboundary disasters in Europe.

Natural hazards and climate-related disasters disregard political borders, where additional barriers can complicate mitigation, response and recovery efforts within and between the sectors of Climate Change Adaptation (CCA) and Disaster Risk Reduction (DRR). The ESPREssO Project (Enhancing Synergies for Disaster Prevention in the European Union) aims to improve management of transboundary disasters by encouraging closer synergies between the CCA and DRR communities. Using targeted stakeholder interviews, questionnaires, Think Tank discussions and purpose-built serious games, ESPREssO draws on both CCA and DRR stakeholder experiences and informed perspectives in order to identify current gaps.

Thrombelastography-Directed Transfusion in Cardiac Surgery: Impact on Postoperative Outcomes.

Background: Transfusion of allogenic blood products is associated with substantial morbidity and increased risk of mortality. Thrombelastography (TEG) to direct transfusion management during and immediately after cardiothoracic surgery reduced blood product usage in our institution. The goal of this study was to quantify the impact of TEG on postoperative outcomes.

Measuring visual attention to faces with cleft deformity.

Background: Limited data are available regarding observers' visual attention to faces with congenital difference. We implemented eye tracking technology to examine this issue, as it pertains particularly to faces with cleft deformity.

Method: Four hundred three observers assessed 273 clinical images, while their eye movements were unobtrusively tracked using an infrared sensor.

Negative world views after trauma: Neurophysiological evidence for negative expectancies.

Objective: Negative views of both the self and the world are commonly seen in individuals who have suffered psychological trauma. These negative cognitions are thought to be significant as they are likely to play a critical role in furthering, if not promoting, other symptoms and exacerbating the dysfunction sometimes seen after a traumatic event. This has led to the inclusion of "persistent negative beliefs and expectations about oneself or the world" in the DSM-5 (American Psychiatric Association, 2013).

TEG-Directed Transfusion in Complex Cardiac Surgery: Impact on Blood Product Usage.

Complex cardiac procedures often require blood transfusion because of surgical bleeding or coagulopathy. Thrombelastography (TEG) was introduced in our institution to direct transfusion management in cardiothoracic surgery. The goal of this study was to quantify the effect of TEG on transfusion rates peri- and postoperatively.

The Multi-Parameter Wireless Sensing System (MPwise): Its Description and Application to Earthquake Risk Mitigation.

The Multi-Parameter Wireless Sensing (MPwise) system is an innovative instrumental design that allows different sensor types to be combined with relatively high-performance computing and communications components. These units, which incorporate off-the-shelf components, can undertake complex information integration and processing tasks at the individual unit or node level (when used in a network), allowing the establishment of networks that are linked by advanced, robust and rapid communications routing and network topologies. The system (and its predecessors) was originally designed for earthquake risk mitigation, including earthquake early warning (EEW), rapid response actions, structural health monitoring, and site-effect characterization.

Hydrogeological characterisation of groundwater over Brazil using remotely sensed and model products.

For Brazil, a country frequented by droughts and whose rural inhabitants largely depend on groundwater, reliance on isotope for its monitoring, though accurate, is expensive and limited in spatial coverage. We exploit total water storage (TWS) derived from Gravity Recovery and Climate Experiment (GRACE) satellites to analyse spatial-temporal groundwater changes in relation to geological characteristics. Large-scale groundwater changes are estimated using GRACE-derived TWS and altimetry observations in addition to GLDAS and WGHM model outputs.

Geodetic measurements reveal similarities between post-Last Glacial Maximum and present-day mass loss from the Greenland ice sheet.

Accurate quantification of the millennial-scale mass balance of the Greenland ice sheet (GrIS) and its contribution to global sea-level rise remain challenging because of sparse in situ observations in key regions. Glacial isostatic adjustment (GIA) is the ongoing response of the solid Earth to ice and ocean load changes occurring since the Last Glacial Maximum (LGM; ~21 thousand years ago) and may be used to constrain the GrIS deglaciation history. We use data from the Greenland Global Positioning System network to directly measure GIA and estimate basin-wide mass changes since the LGM.

Multiorgan Dysfunction Syndrome from Strongyloides stercoralis Hyperinfection in a Patient with Human T-Cell Lymphotropic Virus-1 Coinfection After Initiation of Ivermectin Treatment.

Strongyloides stercoralis is well known to cause hyperinfection syndrome during the period of immunosuppression; but dissemination, worsening hyperinfection, and development of multiorgan dysfunction syndrome after initiation of ivermectin has not been reported in the past. Herein, we describe the case of a 62-year-old man with chronic strongyloidiasis and human T-cell lymphotropic virus-1 coinfection, who developed significant clinical worsening after 24-48 hours of initiation of treatment with ivermectin (200 μg/kg daily). Oral albendazole (600 mg every 12 hours) was added to the regimen due to clinical deterioration.

Central sensitization syndrome and the initial evaluation of a patient with fibromyalgia: a review.

In both primary care and consultative practices, patients presenting with fibromyalgia (FM) often have other medically unexplained somatic symptoms and are ultimately diagnosed as having central sensitization (CS). Central sensitization encompasses many disorders where the central nervous system amplifies sensory input across many organ systems and results in myriad symptoms. A pragmatic approach to evaluate FM and related symptoms, including a focused review of medical records, interviewing techniques, and observations, is offered here, giving valuable tools for identifying and addressing the most relevant symptoms.

The impact of hypervigilance: evidence for a forward feedback loop.

A number of prominent theories suggest that hypervigilance and attentional bias play a central role in anxiety disorders and PTSD. It is argued that hypervigilance may focus attention on potential threats and precipitate or maintain a forward feedback loop in which anxiety is increased. While there is considerable data to suggest that attentional bias exists, there is little evidence to suggest that it plays this proposed but critical role.

Improving efficiency and reducing administrative burden through electronic communication.

Background: The InBox messaging system is an internal, electronic program used at Mayo Clinic, Rochester, MN, to facilitate the sending, receiving, and answering of patient-specific messages and alerts. A standardized InBox was implemented in the Division of General Internal Medicine to decrease the time physicians, physician assistants, and nurse practitioners (clinicians) spend on administrative tasks and to increase efficiency.

Methods: Clinicians completed surveys and a preintervention InBox pilot test to determine inefficiencies related to administrative burdens and defects (message entry errors).

Contributors to hypervigilance in a military and civilian sample.

Hypervigilance toward ambiguous or threatening stimuli is a prominent feature in many trauma survivors including active and returning soldiers. This study set out to investigate the factors that contribute to hypervigilance in a mixed sample. One hundred forty-five individuals, 50 of whom were war zone veterans, filled out a series of questionnaires including the Hypervigilance Questionnaire (HVQ; Kimble, Fleming, & Bennion, 2009).

Negative expectancies in posttraumatic stress disorder: neurophysiological (N400) and behavioral evidence.

Background: Posttraumatic stress disorder (PTSD) is a disorder that theoretically and clinically is thought to be associated with persistent and exaggerated negative expectancies. This study used the N400 event-related potential (ERP) to investigate expectancies for threatening endings to ambiguous sentence stems. The N400 ERP is thought to reflect the amount of effort required to integrate a stimulus into a given context.

Application of GNSS-RTK derived topographical maps for rapid environmental monitoring: a case study of Jack Finnery Lake (Perth, Australia).

In environmental monitoring, environmental impact assessments and environmental audits, topographical maps play an essential role in providing a means by which the locations of sampling sites may be selected, in assisting with the interpretation of physical features, and in indicating the impact or potential impact on an area due to changes in the system being monitored (e.g., spatially changing features such as wetlands).

Attention to novel and target stimuli in trauma survivors.

Trauma and its consequences can have lasting biological and cognitive effects on those who experience them. This study investigated the extent to which trauma, posttraumatic stress disorder (PTSD), and dissociation influenced attention to basic auditory stimuli in a sample of military cadets. After filling out a series of psychometric questionnaires, 27 male military cadets varying in their trauma history participated in the "novelty" oddball task in which participants were asked to count high-pitched tones while ignoring other auditory stimuli.

Eye tracking and visual attention to threating stimuli in veterans of the Iraq war.

Theoretical and clinical characterizations of attention in PTSD acknowledge the possibility for both hypervigilance and avoidance of trauma-relevant stimuli. This study used eye tracking technology to investigate visual orientation and attention to traumatic and neutral stimuli in nineteen veterans of the Iraq war. Veterans saw slides in which half the screen had a negatively valenced image and half had a neutral image.

Decisions to shoot in a weapon identification task: The influence of cultural stereotypes and perceived threat on false positive errors.

The decision to shoot a gun engages executive control processes that can be biased by cultural stereotypes and perceived threat. The neural locus of the decision to shoot is likely to be found in the anterior cingulate cortex (ACC), where cognition and affect converge. Male military cadets at Norwich University (N=37) performed a weapon identification task in which they made rapid decisions to shoot when images of guns appeared briefly on a computer screen.

Spreadsheet use to calculate creatinine clearance from serum creatinine.

Spreadsheets may be created to include the Cockcroft-Gault Formula (CGF) for creatinine-based estimation of glomerular filtration rate. Creatinine clearance (CrCl) provides a more accurate method for perioperative risk assessment of renal function than serum creatinine. CrCl may be used to develop guidelines for renal protective management strategies during cardiopulmonary bypass.