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The need to be competent in neuromodulation is and should be a prerequisite prior to completing a fellowship in interventional pain medicine. Unfortunately, many programs lack acceptable candidates for these advanced therapies, and fellows may not receive adequate exposure to neuromodulation procedures. The American Society of Pain and Neuroscience (ASPN) desires to create a consensus of experts to set a minimum standard of competence for neurostimulation procedures, including spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), and peripheral nerve stimulation (PNS). The executive board of ASPN accepted nominations for colleagues with excellence in the subject matter of neuromodulation and physician education. This diverse group used peer-reviewed literature and, based on grading of evidence and expert opinion, developed critical consensus guides for training that all accredited fellowship programs should adopt. For each consensus point, transparency and recusal were used to eliminate bias, and an author was nominated for evidence grading oversight and bias control. Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation sets a standard for neuromodulation training in pain fellowship training programs. The consensus panel has determined several recommendations to improve care in the United States for patients undergoing neuromodulation. As neuromodulation training in the United States has evolved dramatically, these therapies have become ubiquitous in pain medicine. Unfortunately, fellowship programs and the Accreditation Council for Graduate Medical Education (ACGME) pain program requirements have not progressed training to match the demands of modern advancements. PEAK sets a new standard for fellowship training and presents thirteen practice areas vital for physician competence in neuromodulation.

Cassava is a key source of calories for smallholder farmers in sub-Saharan Africa but its role as a food security crop is threatened by the cross-continental spread of cassava brown streak disease (CBSD) that causes high yield losses. In order to mitigate the impact of CBSD, it is important to minimise the delay in first detection of CBSD after introduction to a new country or state so that interventions can be deployed more effectively. Using a computational model that combines simulations of CBSD spread at both the landscape and field scales, we model the effectiveness of different country level survey strategies in Nigeria when CBSD is directly introduced. We find that the main limitation to the rapid CBSD detection in Nigeria, using the current survey strategy, is that an insufficient number of fields are surveyed in newly infected Nigerian states, not the total number of fields surveyed across the country, nor the limitation of only surveying fields near a road. We explored different strategies for geographically selecting fields to survey and found that early and consistent CBSD detection will involve confining candidate survey fields to states where CBSD has not yet been detected and where survey locations are allocated in proportion to the density of cassava crops, detects CBSD sooner, more consistently, and when the epidemic is smaller compared with distributing surveys uniformly across Nigeria. [ABSTRACT FROM AUTHOR]

Wheat contributes one‐fifth of the global food supply with an estimated 29% of global production in low and lower‐middle income countries. As production expands across southern Asia, yields are often negatively impacted by outbreaks of fungal rust diseases. A wheat rust early warning and advisory system comprising surveillance, near real‐time disease risk forecasts and advisory dissemination has been established in two target countries in South Asia, including Nepal and Bangladesh. However, as wheat rust spores can be aerially transmitted over long distances, near real‐time estimates of disease incidence are required from sources of infection in neighbouring regions. To address this challenge, we developed and tested a novel algorithm to generate proxy observations of infection sources using online media reports in two neighbouring countries, India and Pakistan. Media sampling could provide an effective alternative where data from ground surveys are not readily available in near real‐time. Our results show that west Nepal was exposed to a substantial inoculum pressure from aerially dispersed stripe rust spores originating from India and Pakistan. There were no outbreaks of stripe rust disease in Bangladesh with only very low levels of cross‐border dispersion and generally unfavourable environmental conditions for infection. We further describe how proxy observations informed farmer decision‐making in near real‐time in Nepal and filled a knowledge gap in identifying early sources of infection for a major outbreak of stripe rust during 2020 in Nepal. Our results highlight the importance of international cooperation in mitigating transboundary plant pathogens. [ABSTRACT FROM AUTHOR]

Purpose: Chronic, non-cancer pain significantly and negatively impacts patient quality of life. Neuromodulation is a major component of multi-modal interdisciplinary approaches to chronic pain management, which includes opioid and nonopioid medications. In randomized controlled trials, spinal cord stimulation (SCS) has been shown to reduce pain and decrease short-term opioid use for patients. This study sought to evaluate the effect of SCS on longer term opioid and non-opioid pain medication usage among patients over ≥ 3 years of follow-up. Patients and Methods: Claims analysis was conducted using the Merative™ MarketScan® Commercial Database. Patients aged ≥ 18 who initiated SCS between 1/1/2010 and 3/31/2021 with ≥ 1 year of baseline data and ≥ 3 years of follow-up data were included. Opioid discontinuation, daily dose (DD) reduction, proportion of days covered (PDC), concomitant co-medication with benzodiazepines and/or gabapentinoids, and polypharmacy were evaluated during the baseline and follow-up periods. Adjusted logistic regression was used to evaluate the impact of baseline dosages on discontinuation and dose reduction. Results: During follow-up, 60% of 2,669 SCS patients either discontinued opioid use or reduced opioid DD by at least 20% from baseline; another 15% reduced DD by 1– 19%. Logistic regression showed patients with higher baseline dosages were less likely to discontinue opioids completely (odds ratio[OR] 95% confidence intervals[CI]: 0.31[0.18,0.54]) but more likely to reduce their daily dose (OR[CI]: 7.14[4.00,12.73], p< 0.001). Mean PDC with opioids decreased from 0.58 (210 of 365 days) at baseline to 0.51 at year 3 (p< 0.001). With SCS, co-medication with benzodiazepines decreased from 47.3% at baseline to 30.3% at year 3, co-medication with gabapentinoids reduced from 58.6% to 42.2%, and polypharmacy dropped from 15.6% to 9.6% (all p< 0.001). Conclusion: Approximately three-quarters of patients who received SCS therapy either discontinued or reduced systemic opioid use over the study period. SCS could assist in reducing long-term reliance on opioids and other pain medications to treat chronic non-cancer pain. [ABSTRACT FROM AUTHOR]

Sudden oak death, caused by Phytophthora ramorum, has killed millions of oak and tanoak in California since its first detection in 1995. Despite some localized small-scale management, there has been no large-scale attempt to slow the spread of the pathogen in California. Here we use a stochastic spatially explicit model parameterized using data on the spread of P. ramorum to investigate whether and how the epidemic can be controlled. We find that slowing the spread of P. ramorum is now not possible, and has been impossible for a number of years. However, despite extensive cryptic (i.e., presymptomatic) infection and frequent long-range transmission, effective exclusion of the pathogen from large parts of the state could, in principle, have been possible were it to have been started by 2002. This is the approximate date by which sufficient knowledge of P. ramorum epidemiology had accumulated for large-scale management to be realistic. The necessary expenditure would have been very large, but could have been greatly reduced by optimizing the radius within which infected sites are treated and careful selection of sites to treat. In particular, we find that a dynamic strategy treating sites on the epidemic wave front leads to optimal performance. We also find that "front loading" the budget, that is, treating very heavily at the start of the management program, would greatly improve control. Our work introduces a framework for quantifying the likelihood of success and risks of failure of management that can be applied to invading pests and pathogens threatening forests worldwide.