Is Pain "All in your Mind"? Examining the General Public's Views of Pain.

By definition, pain is a sensory and emotional experience that is felt in a particular part of the body. The precise relationship between somatic events at the site where pain is experienced, and central processing giving rise to the mental experience of pain remains the subject of debate, but there is little disagreement in scholarly circles that both aspects of pain are critical to its experience. Recent experimental work, however, suggests a public view that is at odds with this conceptualisation. By demonstrating that the public does not necessarily endorse central tenets of the "mental" view of pain (subjectivity, privacy, and incorrigibility), experimental philosophers have argued that the public holds a more "body-centric" view than most clinicians and scholars. Such a discrepancy would have important implications for how the public interacts with pain science and clinical care. In response, we tested the hypothesis that the public is capable of a more "mind-centric" view of pain. Using a series of vignettes, we demonstrate that in situations which highlight mental aspects of pain the public can, and does, recognize pain as a mental phenomenon. We also demonstrate that the public view is subject to context effects, by showing that the public's view is modified when situations emphasizing mental and somatic aspects of pain are presented together.

Implementation and Evaluation of a Pilot Training to Improve Transgender Competency Among Medical Staff in an Urban Clinic.

Purpose: Transgender individuals (TGI), who identify their gender as different from their sex assigned at birth, continue facing widespread discrimination and mistreatment within the healthcare system. Providers often lack expertise in adequate transgender (TG) care due to limited specialized training. In response to these inadequacies, and to increase evidence-based interventions effecting TG-affirmative healthcare, we implemented and evaluated a structural-level intervention in the form of a comprehensive Provider Training Program (PTP) in TG health within a New York City-based outpatient clinic serving primarily individuals of color and of low socioeconomic status. This pilot intervention aimed to increase medical staff knowledge of TG health and needs, and to support positive attitudes toward TGI. Methods: Three 2-h training sessions were delivered to 35 clinic staff across 4 months by two of the authors experienced in TG competency training; the training sessions included TG-related identity and barriers to healthcare issues, TG-specialized care, and creating TG-affirmative environments, medical forms, and billing procedures. We evaluated changes through pre-post intervention surveys by trainees. Results: Compared to pre-training scores, post-training scores indicated significant (1) decreases in negative attitudes toward TGI and increases in TG-related clinical skills, (2) increases in staff's awareness of transphobic practices, and (3) increases in self-reported readiness to serve TGI. The clinic increased its representation of general LGBT-related images in the waiting areas, and the staff provided highly positive training evaluations. Conclusion: This PTP in TG health shows promise in leading to changes in provider attitudes and competence, as well as clinic systems, especially with its incorporation in continuing education endeavors, which can, in turn, contribute to health disparities reductions among TG groups.

Implementing an acuity-adaptable care model in a rural hospital setting.

OBJECTIVE: This study examined the effects of an acuity-adaptable care model in a rural hospital setting on nurse satisfaction, patient satisfaction, patient safety, and quality indicators (events, falls, and medication errors), patient length of stay (LOS), and worked hours per patient-day (WHPPD). BACKGROUND: Acuity-adaptable care models have been implemented as a nursing strategy to improve workflow through the elimination of unit-to-unit patient handoffs. However, to our knowledge, this model of care has not been studied in a rural hospital setting. METHODS: A descriptive, comparative design with repeated measures was utilized for this study. A professional nurse survey was created to measure staff satisfaction; separate t tests for percentages were utilized to evaluate patient satisfaction and patient safety/quality indicators. Financial data were examined to perform the analysis of patient LOS and WHPPD. RESULTS: The nurse satisfaction survey demonstrated a decrease in weekly floating and cancellations due to low census. There was a statistically significant improvement in patient satisfaction for overall rating and willingness to recommend the hospital. No significant difference was noted in patient quality indicators or LOS; however, there was a favorable trend for all events and medication errors. This study also found a decrease in WHPPD, with a corresponding salary expense reduction reported. CONCLUSION: Acuity-adaptable units may be a viable strategy for rural facilities.

An investigation into the enhancement of fingermarks in blood on paper with genipin and lawsone.

The abilities of two natural products, genipin and lawsone, to enhance blood contaminated fingermarks on papers of various porosities and colour were investigated and compared to the routinely used amino acid reagents, ninhydrin and 1,8-diazafluoren-9-one (DFO). Fingermarks in blood were deposited as a split depletion series on various paper types and colours for ageing periods of 6 weeks, 4 weeks, 2 weeks and 1 week before enhancement. The developed marks were observed under different lighting conditions, recorded and graded by way of attributing quantitative data to each series. Results indicated that while genipin showed some potential as a reagent for the enhancement of latent fingermarks, it displayed no suitability for the enhancement of fingermarks in blood on paper. Lawsone also failed to successfully enhance either type of fingermark. Upon comparison of the results with those of ninhydrin and DFO it was found that ninhydrin displayed the highest success rate of development of these marks.

Spatial statistical analysis of adult mosquito (Diptera: Culicidae) counts: an example using light trap data, in Redland Shire, Southeastern Queensland, Australia.

Many mosquito control agencies use carbon dioxide-baited traps as surveillance tools for adult vector populations. However, decisions regarding the number and location of trap sites and the frequency of collections are often based on logistical issues, and not on the bionomics or spatial distribution of the target species. Therefore, with the aim of providing practical information for adult mosquito surveillance programs, we used an array of 81 carbon dioxide- and octenol-baited lights traps to obtain weekly samples of adult mosquitoes in Redland Shire in southeastern Queensland, Australia. The spatial patterns of four different mosquito species were examined, and positive spatial autocorrelation in trap counts was evident for Ochlerotatus vigilax (Skuse), Coquillettidia linealis (Skuse), and Culex annulirostris Skuse, but not for the container species Ochlerotatus notoscriptus (Skuse). Of the three species that exhibited spatially correlated trap counts, the autocorrelation was greatest in Oc. vigilax at a lag distance of 0-1.5 km, with Moran's I values of 0.30-0.64. Moran's I indices were also positive and statistically significant (P < 0.05) at lag distances of 1.5-3.0 and 3.0-4.5 km on each of the 15 sampling occasions. However, at 3.0-4.5 km the Moran's I values were low, which indicated only weak spatial autocorrelation in trap counts. Universal kriging was used to estimate the numbers of each species at unsampled locations throughout the study area, and leave-one-out cross validation analyses indicated that this was a robust method for Cq. linealis and Oc. vigilax. In contrast, trap counts for the container-breeding species Oc. notoscriptus were randomly distributed and the interpolated counts were not reliable. Comparisons of weekly contour maps of adult mosquito counts indicated a consistent spatial pattern for Oc. vigilax and Cq. linealis. Particular geographic areas had consistently high or low numbers of vectors, and these patterns were stable from year to year. Definition of geographic areas with consistently high or low numbers of vectors may allow control activities to be focused in areas with the greatest risk of arbovirus transmission.