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Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects.To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research.A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion.The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain.Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.

Systemic delivery of therapeutic agents remains ineffective against diffuse intrinsic pontine glioma (DIPG), possibly due to an intact blood-brain-barrier (BBB) and to dose-limiting toxicity of systemic chemotherapeutic agents. Convection-enhanced delivery (CED) into the brainstem may provide an effective local delivery alternative for DIPG patients.The aim of this study is to develop a method to perform CED into the murine brainstem and to test this method using the chemotherapeutic agent carmustine (BiCNU). To this end, a newly designed murine CED catheter was tested in vitro and in vivo. After determination of safety and distribution, mice bearing VUMC-DIPG-3 and E98FM-DIPG brainstem tumors were treated with carmustine dissolved in DW 5% or carmustine dissolved in 10% ethanol.Our results show that CED into the murine brainstem is feasible and well tolerated by mice with and without brainstem tumors. CED of carmustine dissolved in 5% DW increased median survival of mice with VUMC-DIPG-3 and E98FM-DIPG tumors with 35% and 25% respectively. Dissolving carmustine in 10% ethanol further improved survival to 45% in mice with E98FM-DIPG tumors.Since genetically engineered and primary DIPG models are currently only available in mice, murine CED studies have clear advantages over CED studies in other animals.CED in the murine brainstem can be performed safely, is well tolerated and can be used to study efficacy of chemotherapeutic agents orthotopically. These results set the foundation for more CED studies in murine DIPG models.

Despite the well-established finding from questionnaire studies that positive expectancies are associated with drinking behavior, there is comparatively little known about the mechanisms through which they may affect drinking behavior. Incentive motivation models suggest that alcohol itself may alter the value of the expected outcomes of drinking. The current study was designed to examine the influence of low-dose alcohol on the activation of alcohol outcome expectancy value.Forty-eight hazardous drinkers (34 men) between the ages of 21 and 35 years were recruited from advertisements in local newspapers for a social drinking study. Participants, whose most frequently consumed beverage was beer, were administered a dose of either alcoholic (8.5%) beer, based on gender and weight to reach a blood alcohol concentration of 40 mg/dl, or an equivalent volume of placebo beer. Following an absorption phase, a computerized evaluative priming task was completed in which participants made a series of judgments about the value of positive and negative outcomes following either alcohol or neutral word primes.Those who consumed alcohol made faster evaluative responses to positive relative to negative outcomes, compared with individuals who consumed the placebo beverage.These findings suggest that moderate doses of alcohol may influence the incentive value of positive relative to negative outcome expectancies. It is suggested that these processes may play a role in patterns of hazardous alcohol use.

The hollow-fibre oxygenator is a key component of any extracorporeal circuit used to provide cardiopulmonary bypass (CPB) during open-heart surgery. Since the oxygenator is placed downstream of the pump, the energy losses over it have a direct impact on the quality of pulsatile pressure and flow waveforms. The objective of this study was to describe the effects of hydrodynamic characteristics of the oxygenator on energy transfer during pulsatile, normothermic CPB. Twenty-three adult patients scheduled for coronary bypass surgery were divided randomly into two groups, using either an oxygenator (Group 1) with a relatively high-resistance and low-compliance (2079 ± 148 dyn.s.cm-5 and 0.00348 ± 0.00071 ml.mmHg-1, respectively) or an oxygenator (Group 2) with a relatively low-resistance and high-compliance (884 ± 464 dyn.s.cm-5 and 0.01325 ± 0.00161 ml .mmHg-1, respectively). During perfusion, pre- and post-oxygenator pressures, radial artery pressure, and blood flow were recorded simultaneously. A 32% decline of mean pressure was observed in Group 1 and a 16% decline in Group 2 (p<0.0001). Another decrease by approximately 73% in mean pressure in the rest of the perfusion system was noted in both groups. The mean radial artery pressure did not differ between the groups (74 ± 6 mmHg in Group 1 and 73 ± 6 mmHg in Group 2, p=0.608). Although lower total energy transfer indices were noticed through the low-resistance oxygenator (Group 2), both oxygenators showed a decrease of the generated pump oscillatory energy of approximately 50%. Despite the differences in resistance and compliance of the hollow-fibre oxygenators used, both oxygenators cause a comparable loss of generated oscillatory energy. Exclusion of the oxygenator downstream of the pulsatile pump would improve energy transfer during CPB.

Abstract In this study, we investigate the driving forces behind the changes in residential energy consumption (REC) in China’s urban and rural areas over the 2001–2012 period. Based on the logarithmic mean Divisia index method, the REC changes are decomposed into seven driving forces, which are climate change, energy price, energy expenditure mix, energy cost share (in total expenditure), expenditure share (in income), per capita income and population effects. According to the results, climate effect due to increasing days with abnormal temperature, energy cost share effect characterized by more expenditure to be paid for energy use, income effect describing constant income growth in the residential sector definitely increase REC in both urban and rural areas. In contrast, energy prices and energy expenditure mix effects negatively contribute to the REC increase, respectively because of the increase in energy prices and the transition from the low-priced energy to high-priced energy. Expenditure share and population effects play opposite roles in urban and rural areas, and the reasons and implications are analysed in depth.

China has achieved impressive rapid economic growth over the past 30 years but accompanied by significant extreme weather events and environmental changes caused by global change and overfast urbanization. Using the absolute hazards index (AHI), we assessed the spatial distribution patterns and related health effects of 4 major extreme natural disasters, including drought, floods (landslides, mudslides), hails, and typhoons from 2000 to 2011 at the provincial level in China. The results showed that (1) central and south China were the most affected by the 4 natural disasters, and north China suffered less; (2) the provinces with higher AHI suffered most from total death, missing people, collapse, and emergently relocated population; (3) the present health emergency response system to disasters in China mainly lacks a multidisciplinary approach. In the concluding section of this article, suggestions on preparedness and rapid response to extreme health events from environmental changes are proposed.

While park-people conflicts have received worldwide attention, the extent of illegal resource extraction and the relationship with communities' livelihoods has gained little attention in the literature. Thus this paper investigates the impact of socio-economic factors involved in illegal fuel wood and fodder extraction at Bardia National Park in Nepal. Household questionnaires, key-informant interviews and focus groups were conducted to identify different plant species used by households and explore the causes and mode of resource extraction in three buffer zone villages in the park. Altogether 50 different plants were identified by villagers that were used regularly for different livelihood purposes. Almost half of the respondents met their needs by illegally and regularly extracting resources from the park. Incentive schemes in the form of development projects were important but not sufficient in meeting the basic needs of households' especially for such daily items such as fuel wood and fodder. The results described in this paper showed that proximity and access to resources either in the national park, the buffer zone community forest or the government forest, and impact on the livelihoods significantly influenced the likelihood of illegal resource extraction activities. Villages that differed in terms of their location to the resource base, the provision of alternative resources and influence of these on their livelihoods showed significant differences in terms of their patterns of resource extraction and use of these resources. As resource use options, resource interest, and resource extraction patterns were different between villages and dependent on circumstances specific to villages, site-specific management strategies were necessary and more influential than the enforcement of 'one-size fits all' policies. It is suggested that park management plans should be flexible and adaptive enough to meet site-specific contexts and to endear wider support from local communities.

What's known on the subject? and What does the study add?Simple renal cysts are a common entity, which may need observation and follow‐up or treatment.The study, for the first time, systematically reviews the indications for follow‐up or radiological treatment of simple renal cysts.To review the conservative and radiological management of simple renal cysts a systematic literature review was performed. Simple renal cysts are commonly found in the adult population. Increasing age is highly associated with its incidence. When they remain asymptomatic they require neither treatment nor follow‐up. When the shape of the cyst is slightly irregular follow‐up is mandatory to exclude malignant progression. Symptomatic cysts require intervention. Ultrasound or computed tomography guidance have been effectively used for cyst puncture. However, simple fluid aspiration is ineffective leading to cyst recurrence. Aspiration should be accompanied with the injection of a sclerosing agent to destroy renal cyst epithelium. Several issues such as the ultimate technique and agent remain to be clarified. High rates of cyst disappearance and long‐lasting cyst volume reduction have been reported with the use of various sclerosants. Ethanol in high concentrations and multiple injections is more commonly used with new agents showing similar efficacy and better complication profile. Studies comparing radiological intervention to surgical excision are lacking. Simple renal cysts may not require treatment when asymptomatic. Radiological intervention with the use of sclerosants needs further evaluation and comparison with other treatment methods.