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The legend of Eli Monpress : volumes I, II, & III
The first three novels about Eli Monpress, \"the greatest thief of the age--[who's] also a wizard. And with the help of his partners--a swordsman with the most powerful magic sword in the world but no magical ability of his own, and a demonseed who can step through shadows and punch through walls--he's going to put his plan into effect\"--Page 4 of cover.
Book
The Early Impact of COVID-19 on Chronic Pain: A Cross-Sectional Investigation of a Large Online Sample of Individuals with Chronic Pain in the United States, April to May, 2020
Abstract
Objective
Individuals with chronic pain are uniquely challenged by the COVID-19 pandemic, as increased stress may exacerbate chronic pain, and there are new barriers to receiving chronic pain treatment. In light of this, using a large online sample in the United States, we examined 1) the early impact of COVID-19 on pain severity, pain interference, and chronic pain management; and 2) variables associated with perceived changes in pain severity and pain interference.
Design
A cross-sectional study.
Methods
Online survey data for 1,453 adults with chronic pain were collected via Amazon’s Mechanical Turk platform.
Results
Although a large proportion of participants reported no perceived changes in their pain severity and pain interference since the outbreak, approximately 25–30% of individuals reported exacerbation in these domains. Individuals identifying as Black and of non-Hispanic origin, who experienced greater disruptions in their mood and sleep quality, were more likely to report worsened pain interference. The majority of participants reported engaging in self-management strategies as usual. However, most appointments for chronic pain treatment were either postponed or canceled, with no future session scheduled. Furthermore, a notable proportion of participants had concerns about or difficulty accessing prescription opioids due to COVID-19.
Conclusions
We may expect to see a long-term exacerbation of chronic pain and related interference in functioning and chronic pain management among individuals most impacted by the pandemic. These individuals may benefit from remotely delivered intervention to effectively mitigate COVID-19–related exacerbations in chronic pain and interruptions in face-to-face treatment.
Journal Article
Qualitative metrics from the biomedical literature for evaluating large language models in clinical decision-making: a narrative review
Background
The large language models (LLMs), most notably ChatGPT, released since November 30, 2022, have prompted shifting attention to their use in medicine, particularly for supporting clinical decision-making. However, there is little consensus in the medical community on how LLM performance in clinical contexts should be evaluated.
Methods
We performed a literature review of PubMed to identify publications between December 1, 2022, and April 1, 2024, that discussed assessments of LLM-generated diagnoses or treatment plans.
Results
We selected 108 relevant articles from PubMed for analysis. The most frequently used LLMs were GPT-3.5, GPT-4, Bard, LLaMa/Alpaca-based models, and Bing Chat. The five most frequently used criteria for scoring LLM outputs were “accuracy”, “completeness”, “appropriateness”, “insight”, and “consistency”.
Conclusions
The most frequently used criteria for defining high-quality LLMs have been consistently selected by researchers over the past 1.5 years. We identified a high degree of variation in how studies reported their findings and assessed LLM performance. Standardized reporting of qualitative evaluation metrics that assess the quality of LLM outputs can be developed to facilitate research studies on LLMs in healthcare.
Journal Article
The OPTIMIZE study: protocol of a pragmatic sequential multiple assessment randomized trial of nonpharmacologic treatment for chronic, nonspecific low back pain
Background
Low back pain is a prevalent condition that causes a substantial health burden. Despite intensive and expensive clinical efforts, its prevalence is growing. Nonpharmacologic treatments are effective at improving pain-related outcomes; however, treatment effect sizes are often modest. Physical therapy (PT) and cognitive behavioral therapy (CBT) have the most consistent evidence of effectiveness. Growing evidence also supports mindfulness-based approaches. Discussions with providers and patients highlight the importance of discussing and trying options to find the treatment that works for them and determining what to do when initial treatment is not successful. Herein, we present the protocol for a study that will evaluate evidence-based, protocol-driven treatments using PT, CBT, or mindfulness to examine comparative effectiveness and optimal sequencing for patients with chronic low back pain.
Methods
The Optimized Multidisciplinary Treatment Programs for Nonspecific Chronic Low Back Pain (OPTIMIZE) Study will be a multisite, comparative effectiveness trial using a sequential multiple assessment randomized trial design enrolling 945 individuals with chronic low back pain. The co-primary outcomes will be disability (measured using the Oswestry Disability Index) and pain intensity (measured using the Numerical Pain Rating Scale). After baseline assessment, participants will be randomly assigned to PT or CBT. At week 10, participants who have not experienced at least 50% improvement in disability will be randomized to cross-over phase-1 treatments (e.g., PT to CBT) or to Mindfulness-Oriented Recovery Enhancement (MORE). Treatment will consist of 8 weekly sessions. Long-term outcome assessments will be performed at weeks 26 and 52.
Discussion
Results of this study may inform referring providers and patients about the most effective nonoperative treatment and/or sequence of nonoperative treatments to treat chronic low back pain.
Trial registration
This study was prospectively registered on March 1, 2019, with
Clinicaltrials.gov
under the registration number NCT03859713 (
https://clinicaltrials.gov/ct2/show/NCT03859713
).
Journal Article
International signal code alphabet
\"International Signal Code Alphabet by Corita Kent, produced in collaboration with the Corita Art Center. Radical American artist, educator and once-devout Catholic nun, Corita Kent's provocative serigraphy has entranced audiences for over four decades. Originally completed in 1968, Kent's Signal Code Alphabet, encompasses a series of 26 kaleidoscopic serigraphs integrating scripture, typography, image, icon, and the maritime flags of the International Code of Signals. As 2018 marks the 50th anniversary of both the series' completion, and the centennial of Kent's birth, the celebratory publication reproduces for the first time, Kent's International Signal Code Alphabet within fine art monograph format. An introduction is authored by Corita Art Center Director, Dr. Ray Smith, accompanied by a foreword authored by artist & curator Aaron Rose\"--Publisher's description.
Book
The Relationship Between Neighborhood Deprivation and Perceived Changes for Pain-Related Experiences Among US Patients with Chronic Low Back Pain During the COVID-19 Pandemic
Abstract
Objective
Disruptions caused by the COVID-19 pandemic could disproportionately affect the health of vulnerable populations, including patients experiencing persistent health conditions (i.e., chronic pain), along with populations living within deprived, lower socioeconomic areas. The current cross-sectional study characterized relationships between neighborhood deprivation and perceived changes in pain-related experiences during the COVID-19 pandemic (early-September to mid-October 2020) for adult patients (N = 97) with nonspecific chronic low back pain.
Methods
We collected self-report perceived experiences from participants enrolled in an ongoing pragmatic randomized trial across medical centers within the Salt Lake City, Utah and Baltimore, Maryland metropolitans. The Area Deprivation Index (composite of 17 US Census deprivation metrics) reflected neighborhood deprivation based on participants’ zip codes.
Results
Although those living in the neighborhoods with greater deprivation endorsed significantly poorer physical (pain severity, pain interference, physical functioning), mental (depression, anxiety), and social health during the pandemic, there were no significant differences for perceived changes in pain-related experiences (pain severity, pain interference, sleep quality) between levels of neighborhood deprivation since the onset of the pandemic. However, those in neighborhoods with greater deprivation endorsed disproportionately worse perceived changes in pain coping, social support, and mood since the pandemic.
Conclusions
The current findings offer evidence that changes in pain coping during the pandemic may be disproportionately worse for those living in deprived areas. Considering poorer pain coping may contribute to long-term consequences, the current findings suggest the need for further attention and intervention to reduce the negative effect of the pandemic for such vulnerable populations.
Journal Article
Nonsuicidal self-injury and diminished pain perception: the role of emotion dysregulation
Nonsuicidal self-injury (NSSI) is the deliberate destruction of one's own body tissue in the absence of suicidal intent (e.g., cutting or burning the skin). Previous studies have found that people with a history of NSSI display diminished pain perception. However, it remains unclear why this effect occurs. In the present study, we used a sample of participants with (n = 25) and without (n = 47) a history of NSSI to test the hypothesis that emotion dysregulation partially explains why NSSI is associated with diminished pain perception. Pain perception was quantified as pain threshold, pain tolerance, and pain intensity ratings assessed during the cold pressor task. Nonsuicidal self-injury was associated with increased emotion dysregulation and diminished pain perception. Results showed that emotion dysregulation was correlated with diminished pain perception within both groups, demonstrating that this association exists regardless of NSSI history. Results also specified that emotion dysregulation partially accounted for the association between NSSI and pain tolerance but not other pain variables. Overall, results were consistent with the hypothesis that emotion dysregulation may increase NSSI risk in part by increasing the willingness to experience the pain involved in self-injury. Studies are needed to more directly investigate this hypothesis.
Journal Article
Emotional awareness and expression therapy (EAET) for chronic pain following traumatic orthopaedic injury and surgery: study protocol for a single-arm feasibility clinical trial
BackgroundNearly half of individuals who sustain orthopaedic trauma develop chronic pain and experience significant levels of depression and anxiety. Emotional awareness and expression therapy (EAET) is a newly developed psychological intervention designed to treat chronic pain by helping patients process psychological trauma and conflict to reduce pain. The purpose of this study is to examine the feasibility of delivering EAET to individuals who sustained traumatic orthopaedic injuries requiring surgery and who have chronic pain 6 months after hospital discharge.Methods and analysisThe study will consist of a single-arm design. Thirty individuals who sustained traumatic orthopaedic injuries requiring surgery and who reported chronic pain 6 months after hospital discharge will be recruited. Participants will receive eight sessions of individually administered EAET delivered via telehealth and complete self-report questionnaires at three timepoints (pretreatment, post-treatment and 3-month follow-up). Quantitative sensory testing will also be done before and after treatment. The primary outcome of the study is feasibility (eg, per cent of eligible patients recruited and per cent of study completers) and acceptability as reported by responses to a self-report questionnaire.Ethics and disseminationThis study has been approved by the Johns Hopkins Institutional Review Board. All data are expected to be collected by 2026, with results of this study to be disseminated via relevant peer-reviewed journals and scientific conferences.Trial registration numberClinicalTrials.gov NCT05989230. Registered on 14 August 2023.
Journal Article