Effectiveness of a 3-week multimodal inpatient pain treatment for adolescents suffering from chronic pain: statistical and clinical significance.

OBJECTIVE: The present study aimed to investigate the effectiveness of a 3-week multimodal inpatient pain program for children and adolescents with chronic pain. METHODS: Effectiveness was investigated for pain-related variables (pain intensity, pain-related disability) and emotional distress in 3 ways: (1) in terms of statistically significant changes; (2) in terms of the clinical significance of these changes by creating post-hoc outcome groups for pain-related variables and emotional distress; and (3) in terms of the clinically significant overall amelioration generalizing the outcome over 3 variables (ie, pain intensity, pain-related disability, and school absence). One hundred sixty-seven adolescents (aged between 11 and 18 y) with various pain disorders (50% with headache) who met inpatient criteria were evaluated at baseline and 3 months posttreatment. RESULTS: Patients demonstrated statistically significant changes in all variables with large to medium effect sizes. Seventy-two percent and 45% of the patients demonstrated clinically significant changes in pain intensity and pain-related disability, respectively. The percentages of patients demonstrating clinically significant change in emotional distress ranged from 13% to 26%. Seventy-seven adolescents demonstrated overall amelioration. DISCUSSION: Results of the study are promising in at least 2 ways: (1) a multimodal inpatient program might stop the negative effects of chronic pain, disability, and emotional distress in children and adolescents, and (2) the exploration of clinical significance testing has demonstrated utility and can be applied to future effectiveness studies in pediatric pain.

Impact of engine lubricant properties on regulated gaseous emissions of 2000-2001 model-year gasoline vehicles.

The impact of the sulfur (S) content in lubricating oil was evaluated for four ultra-low-emission vehicles and two super-ultra-low-emission vehicles, all with low mileage. The S content in the lube oils ranged from 0.01 to 0.76%, while the S content of the gasoline was fixed at 0.2 ppmw. Vehicles were configured with aged catalysts and tested over the Federal Test Procedure, at idle and at 50-mph cruise conditions. In all testing modes, variations in the S level of the lubricant did not significantly affect the regulated gas-phase tailpipe emissions. In addition to the regulated gas-phase emissions, a key element of the research was measuring the engine-out sulfur dioxide (SO2) in near-real-time. This research used a new methodology based on a differential optical absorption spectrometer (DOAS) to measure SO2 from the lubricants used in this study. With the DOAS, the contribution of SO2 emissions for the highest-S lubricant was found to range from less than 1 to 6 ppm on a gasoline S equivalent basis over the range of vehicles and test cycles used. The development and operation of the DOAS is discussed in this paper.

Investigation of NH3 emissions from new technology vehicles as a function of vehicle operating conditions.

The objective of this study was to measure ammonia (NH3) emissions from modern technology vehicles since information is scarce aboutthis importantsource of particulate matter (PM) precursors. Test variables included the emission level to which the vehicle was certified, the vehicle operating conditions, and catalyst age. Eight vehicles with low-emission vehicle (LEV) to super-ultralow-emission vehicle (SULEV) certification levels were tested over the Federal Test Procedure (FTP75), a US06 cycle, a hot running 505, a New York City Cycle (NYCC), and a specially designed Modal Emissions Cycle (MEC01v7) using both as-received and bench-aged catalysts. NH3 emissions in the raw exhaust were measured by tunable diode laser (TDL) absorption spectroscopy. The results show that NH3 emissions depend on driving mode and are primarily generated during acceleration events. More specifically, high NH3 emissions were found for high vehicle specific power (VSP) events and rich operating conditions. For some vehicles, NH3 emissions formed immediately after catalyst light-off during a cold start.