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Objective: To develop sets of core and optional recommended domains for describing and evaluating Osteoarthritis Management Programs (OAMPs), with a focus on hip and knee Osteoarthritis (OA). Design: We conducted a 3-round modified Delphi survey involving an international group of researchers, health professionals, health administrators and people with OA. In Round 1, participants ranked the importance of 75 outcome and descriptive domains in five categories: patient impacts, implementation outcomes, and characteristics of the OAMP and its participants and clinicians. Domains ranked as “important” or “essential” by ≥80% of participants were retained, and participants could suggest additional domains. In Round 2, participants rated their level of agreement that each domain was essential for evaluating OAMPs: 0 = strongly disagree to 10 = strongly agree. A domain was retained if ≥80% rated it ≥6. In Round 3, participants rated remaining domains using same scale as in Round 2; a domain was recommended as “core” if ≥80% of participants rated it ≥9 and as “optional” if ≥80% rated it ≥7. Results: A total of 178 individuals from 26 countries participated; 85 completed all survey rounds. Only one domain, “ability to participate in daily activities”, met criteria for a core domain; 25 domains met criteria for an optional recommendation: 8 Patient Impacts, 5 Implementation Outcomes, 5 Participant Characteristics, 3 OAMP Characteristics and 4 Clinician Characteristics. Conclusion: The ability of patients with OA to participate in daily activities should be evaluated in all OAMPs. Teams evaluating OAMPs should consider including domains from the optional recommended set, with representation from all five categories and based on stakeholder priorities in their local context.

Introduction We assessed students' perception of the impact of the pandemic on their well-being, education, academic achievement, and whether grit and resilience alter students’ ability to mitigate the stress associated with disruptions in education. We hypothesized that students would report a negative impact, and those with higher grit and resilience scores would be less impacted. Methods A multidisciplinary team of educators created and distributed a survey to medical students. Survey results were analyzed using descriptive statistics, ANOVA, and multivariate linear regressions. A p-value

Pyrithione exhibits size-selective dimerization across the f-block. Experimental and computational analysis shows the Am complex contains greater covalency compared to the Nd analog.

Despite the significant impact of radiation-induced redox reactions on the accessibility and lifetimes of actinide oxidation states, fundamental knowledge of aqueous actinide metal ion radiation chemistry is limited, especially for the late actinides. A quantitative understanding of these intrinsic radiation-induced processes is essential for investigating the fundamental properties of these actinides. We present here a picosecond electron pulse reaction kinetics study into the radiation-induced redox chemistry of trivalent berkelium (Bk(III)) and californium (Cf(III)) ions in acidic aqueous solutions at ambient temperature. New and first-of-a-kind, second-order rate coefficients are reported for the transient radical-induced reduction of Bk(III) and Cf(III) by the hydrated electron (e

So called third culture kids (TCKs), the children and adolescents who accompany their parents on long-term overseas work assignments, often have to face life changes, cultural challenges and threats to social identity. The frequency, intensity and nature of these challenges arguably places some TCKs at heightened risk of stress-related mental health problems. Trait mindfulness, an attribute that can be enhanced through intervention, has been found to buffer against stress reactivity and common mental health problems. This study aims to explore the relationship between stress reactivity, trait mindfulness and depressive symptomatology among expatriate adolescents (TCKs) attending an international school in the United Arab Emirates (UAE). Participants included 230 high school students (57% female) from 45 different nations, with a mean age of 15.5 (±1.3, 12–19). Forty one percent had lived in the UAE for 7+ years. Participants completed measures of trait mindfulness, daily life stress reactivity, and depressive symptoms (CES-D). Mean depression score was high with 68.7% of TCK participants presenting as at risk of clinical depression. Lower stress-reactivity and greater trait mindfulness were associated with lower levels of depression; furthermore, low levels of trait mindfulness partially mediated the relationship between stress reactivity and depression. Efforts that aim to reduce stress reactivity and increase mindfulness might prove especially beneficial among the TCK population.

Chronic pelvic pain (CPP) in women is often associated with marked emotional distress and disability, with particular impairments in sexual functioning. Research supports the efficacy of interdisciplinary chronic pain rehabilitation programs (ICPRPs) in treating chronic pain, however less is known about their utility in CPP.This retrospective study examined pain-related sexual impairment, emotional symptoms, and pain severity in CPP patients before and after completing a 3-4 week ICPRP. Predictors of post-treatment sexual impairment were also investigated. Participants included 58 female CPP patients and 58 age-matched females with non-pelvic chronic pain (NPCP).All participants reported robust improvements across outcome measures. Women with CPP reported greater pre- and post-treatment impairment in sexual function than NPCP patients, despite significant treatment-related improvements. In contrast, CPP patients also reported higher levels of depression at baseline but showed greater treatment related-improvements. In participants with CPP, treatment-related improvements in depression, alexithymia, and pain severity significantly explained decreases in pain-related sexual impairment following treatment, whereas none of these variables explained sexual impairment outcomes in women with NPCP.Results demonstrate that ICPRPs can effectively treat CPP, particularly through changes in depression and alexithymia. Future research should examine whether specific interventions can be added in ICPRPS to address CPP-related sexual impairment.

We present a study of the development of L2 stop VOT (voice onset time) in lower-level English-speaking learners of Spanish over the course of a college semester. Participants were recorded six times in two-week intervals. Halfway through the semester, students received a brief pronunciation training session with practice and feedback. Overall, the learners did not lower their L2 VOTs in the first half of the study, before pronunciation training. Following training, however, they lowered their mean VOTs for Spanish voiceless stops significantly. A similar effect was not found for their mean VOTs of Spanish voiced stops, in line with prior work suggesting that prevoicing may be harder to acquire. Yet careful examination suggests that learners are increasing the frequency with which they use prevoicing in Spanish, suggesting this metric might inform future work on L2 Spanish pronunciation development. This work has implications for teaching and research in second language pronunciation.

Patients treated in interdisciplinary chronic pain rehabilitation programs show long-term improvements in symptoms; however, outcomes may vary across heterogenous patient subpopulations. This longitudinal retrospective study characterizes the influence of opioids, mood, patient characteristics, and baseline symptoms on pain and functional impairment (FI) in 1,681 patients 6-months to 12-months post-treatment in an interdisciplinary chronic pain rehabilitation program incorporating opioid weaning. Linear mixed models showed immediate and durable treatment benefits with nonuniform worsening at follow up which slowed over time. Latent class growth analysis identified three post-treatment trajectories of pain and FI: mild symptoms and durable benefits, moderate symptoms and durable benefits, and intractable symptoms. A fourth pain trajectory showed immediate post-treatment improvement and worsening at follow up. Whether a patient was weaned from opioids was not predictive of treatment trajectory. Racial ethnic minority status, higher levels of post-treatment depression, and lower perceived treatment response were associated with less resolution (moderate symptoms) or intractable symptoms. Not having a college education was predictive of intractable or worsening pain and a moderate course of FI. Older age and male gender was associated with intractable FI. Treatment outcomes may be improved by the development of targeted interventions for patients at risk of poor recovery and/or deteriorating long-term course. PERSPECTIVE: This study examined predictors of treatment response in 1,681 patients treated in an interdisciplinary chronic pain rehabilitation program incorporating opioid weaning. Opioid weaning did not predict outcome. Higher levels of symptoms, lower levels of education, and being a racial-ethnic minority were associated with a less salubrious long-term treatment response.

The interplay of bond strength and covalency are examined in AnO2Cl2(OPcy3)2(An = Pu, U) complexes. The synthesis oftrans-PuO2Cl2(OPcy3)2,1-Pu, has been carried out and confirmed by single crystal X-ray diffraction along with UV-vis-NIR, and31P NMR spectroscopies. Theoretical analysis finds that despite a higher calculated covalency for the Pu-Cl interaction, the Pu-OPcy3interaction is stronger due to the accumulation of electron density in the interatomic region. The coordination of equatorial ligands slightly decreases the strength of the Pu Oylinteractions relative to the free gas phase (PuO2)2+ion.

An approach to obtaining substantial amounts of data from a hazardous starting material that can only be obtained and handled in small quantities is demonstrated by the investigation of a single small-scale reaction of cyclooctatetraene, C8H8, with a solution obtained from the reduction of Cp'3Pu (Cp' = C5H4SiMe3) with potassium graphite. This one reaction coupled with oxidation of a product has provided single-crystal X-ray structural data on three organoplutonium compounds as well as information on redox chemistry thereby demonstrating an efficient route to new reactivity and structural information on this highly radioactive element. The crystal structures were obtained from the reduction of C8H8 by a putative Pu(II) complex, (Cp'3PuII)1-, generated in situ, to form the Pu(III) cyclooctatetraenide complex, [K(crypt)][(C8H8)2PuIII], 1-Pu, and the tetra(cyclopentadienyl) Pu(III) complex, [K(crypt)][Cp'4PuIII], 2-Pu. Oxidation of the sample of 1-Pu with Ag(I) afforded a third organoplutonium complex that has been structurally characterized for the first time, (C8H8)2PuIV, 3-Pu. Complexes 1-Pu and 3-Pu contain Pu sandwiched between parallel (C8H8)2- rings. The (Cp'4PuIII)- anion in 2-Pu features three η5-Cp' rings and one η1-Cp' ring, which is a rare example of a formal Pu-C η1-bond. In addition, this study addresses the challenge of small-scale synthesis imparted by radiological and material availability of transuranium isotopes, in particular that of pure metal samples. A route to an anhydrous Pu(III) starting material from the more readily available PuIVO2 was developed to facilitate reproducible syntheses and allow complete spectroscopic analysis of 1-Pu and 2-Pu. PuIVO2 was converted to PuIIIBr3(DME)2 (DME = CH3OCH2CH2OCH3) and subsequently PuIIIBr3(THF)x, which was used to independently synthesize 1-Pu, 2-Pu, and 3-Pu.

We test how the compactness of L1 and L2 sound categories may reflect individual differences in L2 sound acquisition. To this end, we examined the speech of ten L1 English-L2 Spanish learners over one semester in early Spanish courses. We analyzed VOT values of voiceless word-initial stops produced during word- list reading tasks in both languages. The results show that L1 English VOT compactness at the beginning of the semester correlated with L2 Spanish VOT accuracy at the end of the semester for all learners (R2 =.663, F(1,9)=15.7, p=.004). This finding indicates that L1 category compactness may reflect speaker characteristics, such as production precision, which influence progress in L2 learning. Moreover, we found that lower, more target-like L2 Spanish VOT correlated with higher L2 Spanish VOT standard deviation at the end of the semester for all learners but those with the most target-like pronunciation (R2 = .562, F(1,7) =7.71, p =.032). This suggests that speakers with relatively target-like L2 pronunciations may show more compact categories; yet, for early learners with non-target-like pronunciations, L2 categories may expand as production improves. In sum, L2 categories seem to reflect both a learner's personal production precision and their specific time-point in their L2 pronunciation development.

L1 and L2 category compactness have been reported to correlate with L2 vowel pronunciation accuracy in advanced intermediate learners (Kartushina and Frauenfelder, 2014). However, it is not clear whether category compactness is an effect of L2 learning, or whether it is an individual characteristic that might predict aspects of L2 learning. Holliday (2015) suggests that more variable VOT categories early in L2 learning may facilitate acquisition of new L2 VOT patterns. We tested relationships between L1 and L2 category compactness and L2 pronunciation progress for voiceless stops, in ten L1 English-L2 Spanish learners over the course of one semester of early Spanish courses. We found that lower L2 Spanish VOT correlated with higher voiceless VOT standard deviation at the end of the semester for all but the absolute beginners (R2 = 0.6256, F(1,5) = 37.75, p = 0.004). Thus, for early learners, as production improves, L2 categories may expand. In addition, L1 English voiceless stop VOT category compactness at beginning of term correlated with L2 Spanish VOT accuracy at end of term for all learners (R2 = 0.6798, F(1,9) = 17.0, p = 0.003), suggesting that L1 category compactness may reflect individual properties that influence progress in L2 learning.

To be understood, non-native speakers must adapt their speech in order to produce contrasts in their second language (L2) that are not present in their first language (L1). Here we examine mechanisms hypothesized to facilitate such adaptation within spoken dialogue: priming, affiliation, and audience design. In two experiments, Korean non-native speakers of English interacted in a referential communication task with a Korean English-speaking confederate (Experiment 1) and a monolingual American English-speaking confederate (Experiments 1 and 2). The task required them to spontaneously produce labels containing segments from English that do not exist in Korean (/ae/ and coda /b/), which, when spoken with a Korean accent, can result in ambiguous homophones (e.g., pat pronounced like pet, or mob pronounced like mop). The Koreans produced more English-like phonetic segments not only immediately after hearing similar segments primed by the American partner, but also when the task required the partner to distinguish two potentially ambiguous items. The first time the Koreans referred to potentially ambiguous objects, utterances took longer to initiate; once they were aware of the potential for ambiguity, initiating contrasting labels took no more time than initiating labels primed by the partner. Findings suggest that priming effects in dialogue are not obligatory but may be motivated, and that phonetic adaptation is shaped by awareness of a partner’s pragmatic needs.

Increased prescribing of opioids for chronic noncancer pain is associated with significant social costs, including overdose and addiction. In this context, there is interest in interdisciplinary chronic pain rehabilitation programs focusing on self-management and minimizing opioid use. This study examined outcomes of patients weaned from opioids in an ICPRP from 2007 to 2012. Participants included 413 patients on high dose chronic opioid therapy (COT; >100 mg), 528 on low dose COT, and 516 not on opioids (NO). Outcomes were assessed at discharge, 6, and 12 months posttreatment through self-report and chart review. One thousand one hundred ninety-four participants completed treatment (81.95%); 86.74% of those on opioids were weaned. High doses were less likely to complete (78.45%) than NO participants (85.27%; P < 0.05). Results showed immediate (P < 0.01) and sustained improvements (P < 0.05) in pain severity, depression, anxiety, and functional impairment with no group differences. Effect sizes ranged from medium to large (Cohen d values 0.57-1.96). Longitudinal medication use data were available for 319 no dose and 417 weaned participants; opioid resumption rates were 10.51% and 30.70% respectively. There were no differences in resumption between the high dose and low dose groups. Logistic regression analyses determined that opioid dose predicted neither treatment completion nor opioid resumption. Anxiety predicted completion, and functional impairment predicted opioid resumption within 1 year of discharge. Results suggest that patients on COT can be successfully weaned with long-term benefits in pain, mood, and function. Targeting anxiety and functional restoration may increase success rates.

Though the debate over the validity of qualitative research and its existence within the field of psychology has somewhat diminished over the years, negotiations over its location and form continue. This article examines the pressure on qualitative researchers to acculturate and adapt in order to gain legitimacy and acceptance in a field dominated by quantitative research. We treat the emergence of qualitative methods as a form of contact between differing (research) cultures, with the concomitant adjustments and accommodations, and we utilize Berry's (1980, 2005) typology of acculturation as a lens through which to examine these intercultural interactions. We examine, in particular detail, the experiences of qualitative researchers within counseling psychology, as that is the subdiscipline which has most explicitly defined itself as welcoming qualitative research. It is our view that qualitative researchers, within psychology in general, have adopted an acculturation strategy of assimilation rather than ...

Genetic selection has been very successful at significantly increasing BW and breast muscle proportion in commercial broiler and turkey strains. The mechanisms of breast muscle growth in poultry and the interactive effects of nutritional status and selection are not fully understood. The hypothesis underlying the current study is that feed restriction, simply as a vehicle for controlling early growth, would delay the temporal expression pattern of neonatal (nMyHC) and adult (aMyHC) fast skeletal muscle myosin heavy chain (MyHC) isoforms in the pectoralis major muscle of turkey poults. The poultry growth model used to evaluate this hypothesis consisted of a randombred control turkey line (RBC2) that represents commercial turkeys of the 1960s and a line developed from the RBC2 by selection for BW at 16 wk of age (F line). The F line has significantly heavier breast muscles than the RBC2 concomitant with increased BW, but the proportion of breast muscle relative to BW is similar. A quantitative indirect ELISA using fast skeletal MyHC isoform specific monoclonal antibodies revealed no significant line differences in the temporal expression of posthatch fast skeletal muscle MyHC in ad libitum fed poults. Feed restriction, however, altered the temporal expression patterns of nMyHC and aMyHC in both F line and RBC2 poults compared with the poults fed ad libitum.

This paper analyzes the voiced:voiceless stop contrast in Spanish and English in the early stages of L1 English-L2 Spanish learners' acquisition. Previous research suggests that corresponding L1 and L2 categories interact in early L2 acquisition, and that L2 learning can lead to assimilatory L1 drift (Chang 2012). Four speakers' pronunciations were analyzed, for English and Spanish, during the second and sixth week of a first-semester Spanish course. It was predicted that progress toward Spanish-like VOT values might be impacted by learners' need to keep sounds in the two languages distinct, which could limit or prevent assimilatory drift. At both time points, VOTs for Spanish and English voiceless stops show that speakers are in the process of differentiating the languages. Between Week 2 and 6, learners progress in L2 and, in one case, dissimilate L1. Only one speaker shows assimilatory L1 drift. For voiced stops, the languages are not as well differentiated, but most speakers reorganize their phonetic space between Week 2 and 6 to use fewer negative VOT values for English compared to Spanish. Overall, the data indicate that learners move toward differentiating their two languages early in L2 acquisition and that L1 contrasts can impact this differentiation.

Level of Evidence: V, Expert Opinion

A simple, inexpensive instrument for measuring radiation fields in otherwise inaccessible locations has been developed. The RadRope consists of a series of radiation detectors inside a flexible sheath and connected to a data readout device to alert the operator to unexpected radiation fields at a remote location. The instrument is designed for use in a maritime environment and will assist inspection personnel in detecting potential illicit radioactive materials or radiological/nuclear weapons of mass destruction.

Fasting glucose and insulin are intermediate traits for type 2 diabetes. Here we explore the role of coding variation on these traits by analysis of variants on the HumanExome BeadChip in 60,564 non-diabetic individuals and in 16,491 T2D cases and 81,877 controls. We identify a novel association of a low-frequency nonsynonymous SNV in GLP1R (A316T; rs10305492; MAF=1.4%) with lower FG (β=-0.09±0.01mmoll-1, P=3.4 × 10-12), T2D risk (OR[95%CI]=0.86[0.76-0.96], P=0.010), early insulin secretion (β=-0.07±0.035pmolinsulin mmolglucose-1, P=0.048), but higher 2-h glucose (β=0.16±0.05mmoll-1, P=4.3 × 10-4). We identify a gene-based association with FG at G6PC2 (p SKAT =6.8 × 10-6) driven by four rare protein-coding SNVs (H177Y, Y207S, R283X and S324P). We identify rs651007 (MAF=20%) in the first intron of ABO at the putative promoter of an antisense lncRNA, associating with higher FG (β=0.02±0.004mmoll-1, P=1.3 × 10-8). Our approach identifies novel coding variant associations and extends the allelic spectrum of variation underlying diabetes-related quantitative traits and T2D susceptibility. © 2015 Macmillan Publishers Limited. All rights reserved.

Theataxiamutation (axJ) is a recessive neurological mutation that results in reduced growth, ataxia, and hindlimb muscle wasting in mice. TheaxJgene encodes ubiquitin-specific protease 14 (Usp14), a deubiquitinating enzyme (DUB) that associates with the proteasome via its ubiquitin-like (Ubl) domain and is involved in processing ubiquitin chains. Analysis ofUsp14gene products demonstrated thatUsp14undergoes alternative pre-mRNA splicing to produce a full-length form of Usp14 that is capable of binding proteasomes and a form that contains a deletion in the Ubl domain. The full-length form of Usp14 is the only form that appears to be reduced in theaxJmice. Transgenic rescue of theaxJmice with neuronal-specific expression of Usp14 demonstrated that the full-length form of Usp14 was sufficient to restore viability and motor system function to theaxJmice. Biochemical analysis showed that the ubiquitin hydrolyase activity of this form of Usp14 is dependent on the presence of proteasomes, and neuronal expression of full-length Usp14 was able to restore the levels of monomeric ubiquitin in the brains ofaxJmice. However, theaxJ-rescued mice still displayed the Purkinje cell axonal swellings that are seen in theaxJmice, indicating that this cerebellar alteration is not the primary cause of theaxJmovement disorders. These results show that the motor defects observed in theaxJmice are attributable to a neuropathic disease rather than to a muscular disorder and suggest that changes in proteasomal function may contribute to neurological dysfunction in theaxJmice.

Our study compared the processing and production of English focus prosody by native speakers of English and Mandarin. Twenty-one Mandarin speakers living in the US and 21 English speakers participated in two tasks. In the processing task, participants responded to instructions that contained natural or unnatural contrastive prosody (Click on the purple sweater; Now click on the SCARLET sweater/Now click on the PURPLE jacket.) In the production task, participants guided an experimenter to place colored objects on a white board, with some contexts designed to elicit contrastive focus (Put the yellow arrow over the ORANGE arrow/yellow DIAMOND, please). All adjectives and nouns were bisyllabic trochees. The two groups differed in their realization of focus, with English speakers tending to align the pitch peak with the stressed syllable and Mandarin speakers with the right edge of the focused word. However, comparison of reaction times for the processing task indicated that both groups responded more quickly ...

In contrast to predictions of the Speech Learning Model, Chang’s (2012) study of novice English-speaking learners of Korean finds no clear segment level assimilation between phonetically similar English and Korean vowels. The relative complexity of the Korean and English vowel systems may have made L2 to L1 vowel association inconsistent across speakers, leading to contradictory segment level effects. We examined vowels in L1 English:L2 Japanese learners, hypothesizing that the less dense vowel space in Japanese would simplify L1:L2 segment associations. Specifically, English [ɑ] and Japanese [a] should be associated by learners in a way that could lead to segment level L1 drift effects, allowing us to determine whether assimilatory L1 drift would occur in English for novice learners of Japanese, as Flege (1987, 1995) and Chang predict. Formant data for students in their first and second semester of Japanese instruction show mostly L1 assimilatory drift in F1, and some L1 dissimilation in F2, with most sp...

Dynamic L2 effects on L1 phonetics appear in experienced and novice second language learners, raising the question of what linguistic and cognitive factors determine their occurrence, degree, and direction (assimilatory versus dissimilatory). Unlike Chang (2012), our longitudinal data from voiceless stops in early L1 English:L2 Japanese learners show primarily dissimilatory increase in English VOTs, an effect found most strongly early in their first semester. Assimilatory L1 drift toward the lower VOTs of L2 Japanese may be disfavored because a decrease in English voiceless stop VOT could threaten the L1 contrast between long and short lag stops. Furthermore, dissimilatory VOT increase on voiceless stops allows English speakers to distinguish phonetically similar L1 and L2 voiceless stops (e.g., Flege and Eefting 1987). These two principles predict that our voiced stop data could show increased L1 prevoicing (an assimilatory effect that would not endanger the English voicing contrast), while also displaying non-identical prevoicing/short-lag values for L1 and L2 voiced stops (separating the languages, as for Huffman and Schuhmann’s (2016) English-Spanish learners). Overall, our data suggest that L1 changes in early L2 learning can be dissimilatory, and that phonetic properties of L1 and L2 contrasts affect how L1 values restructure during early L2 acquisition.Dynamic L2 effects on L1 phonetics appear in experienced and novice second language learners, raising the question of what linguistic and cognitive factors determine their occurrence, degree, and direction (assimilatory versus dissimilatory). Unlike Chang (2012), our longitudinal data from voiceless stops in early L1 English:L2 Japanese learners show primarily dissimilatory increase in English VOTs, an effect found most strongly early in their first semester. Assimilatory L1 drift toward the lower VOTs of L2 Japanese may be disfavored because a decrease in English voiceless stop VOT could threaten the L1 contrast between long and short lag stops. Furthermore, dissimilatory VOT increase on voiceless stops allows English speakers to distinguish phonetically similar L1 and L2 voiceless stops (e.g., Flege and Eefting 1987). These two principles predict that our voiced stop data could show increased L1 prevoicing (an assimilatory effect that would not endanger the English voicing contrast), while also displayi...

Limited research examines the risk of therapeutic opioid addiction (TOA) in patients with chronic noncancer pain. This study examined TOA among 199 patients undergoing long-term opioid therapy at the time of admission to a pain rehabilitation program. It was hypothesized that nonopioid substance use disorders and opioid dosage would predict TOA. Daily mean opioid dose was 132.85 mg ± 175.39. Patients with nonopioid substance use disorders had 28 times the odds (odds ratio [OR] = 28.58; 95% confidence interval [CI] = 10.86, 75.27) of having TOA. Each 50-mg increase in opioid dose nearly doubled the odds of TOA (OR = 1.73; 95% CI = 1.29, 2.32). A 100-mg increase was associated with a 3-fold increase in odds (OR = 3.00; 95% CI = 1.67, 5.41). Receiver operating characteristic analysis revealed that opioid dose was a moderately accurate predictor (area under the curve = .75; 95% CI = .68, .82) of TOA. The sensitivity (.70) and specificity (.68) of opioid dose in predicting TOA was maximized at 76.10 mg; in addition, 46.00 mg yielded 80% sensitivity in identifying TOA. These results underscore the importance of obtaining a substance use history prior to prescribing and suggest a low screening threshold for TOA in patients who use opioids in the absence of improvement in pain or functional impairment. Perspective This article examines TOA in patients with chronic noncancer pain undergoing long-term opioid therapy. Results suggest that patients should be screened for nonopioid substance use disorders prior to prescribing. In the absence of improvement in pain or function, there is a low threshold (∼50 mg daily opioid dose) for addiction screening.

Bei der Behandlung von chronischen Nicht-Tumor-Schmerzen mit Opioiden kann sich eine Abhangigkeitserkrankung entwickeln. Bei welchen Patienten dieses Risiko besonders hoch ausfallt, wurde bislang aber wenig untersucht. Dass eine fruhere Abhangigkeitserkrankung ein relevanter Risikofaktor sein konnte, scheint theoretisch naheliegend, aber in den meisten Studien werden genau diese Patienten ausgeschlossen. Ein Zentrum aus Cleveland hat sich nun damit beschaftigt.

Several of the diachronic seriations proposed for Bantu languages assume a relatively early process of nasal devoicing which preceded, and set the stage for, development of stop aspiration (e.g., Kerremans 1980; Hinnebusch, Nurse and Mould 1981). Maddieson (1991) has argued convincingly that one synchronic reflex, an aspirated nasal in Sukuma, may have developed without an intervening stage involving a voiceless nasal. However, reflexes reportedly involving voiceless nasals or nasal loss might still be thought to motivate a seriation that posits a stage with voiceless nasals. We will argue that even these reflexes need not have developed from an intervening stage in which the nasal was phonologically voiceless. For one thing, developments in feature theory argue against representations which posit a phonologically voiceless nasal and following aspirated stop. Furthermore, our phonetic data on Pokomo suggest that nasal voicelessness can result from a phonetic effect - temporal overlap between the nasal and the aspiration gesture for the following stop. We propose that changes in phonetic detail such as the magnitude and timing of gestures produced nasal voicelessness or partial voicelessness, phonetic conditions which led to phonological restructuring in many of the Bantu languages.

In some languages, syllable weight depends exclusively on vowel length, while in others, coda consonants add weight to syllables. In this paper we assume that syllable weight is reflected in moraic structure, and that weight-bearing coda consonants are the exclusive dependents of a mora, while weightless consonants share a mora with the preceding vowel. We consider whether the durations of vowels and coda consonants reflect the distinction between a segment which occupies its own mora and a segment that shares a mora. We examine three patterns of coda weight, reflected in stress assignment: in Hindi, codas always contribute to syllable weight; in Malayalam, coda consonants are always weightless; and in Levantine Arabic, coda weight is contextually determined, with word-internal codas contributing to syllable weight following a short vowel, but weightless following a long vowel. These phonological patterns translate into different moraic representations of CVC and CVVC syllables across the different languages. We examine the durations of vowels and coda consonants in CV, CVC, CVV and CVVC syllables in Hindi, Malayalam and Levantine Arabic, and find that in all three languages, segments that we represent as mora-sharing are significantly shorter than segments that we represent as occupying an independent mora. The striking differences in durational patterns across the three languages correlate with the different moraic representations proposed on the basis of phonological patterning.

The English /l/ is often described as having a finite number of contextually determined allophones: a backer, “velarize d”, allophone in syllable rimes, a fronter allophone in syllable onsets, and a syllabic allophone, a special variant of the back /l/, in stressless syllables. In contrast, Sproat & Fujimura (1993) argued that variation in /l/ quality is a more continuous phenomenon, governed by principles of phonetic implementation determining the timing and extent of an apical gesture and a dorsal gesture for /l/. They claimed that the /l/'s dorsum-backing gesture is attracted to the syllable nucleus. Therefore in rimes, dorsum backing begins well before the apical gesture, and the longer the rime, the more extensive the backing. In onsets, on the other hand, the dorsum gesture is either simultaneous with, or follows, the apical gesture, which means that /l/ is short, and there is little time for backing. The study reported here investigates the relation between timing and quality in intervocalic onset /l/'s following schwa, a segmental context expected to produce considerable temporal variation across tokens, but which, according to Sproat and Fujimura's model, should not show much variation in degree of backness. Acoustic data from eight female speakers reading in a fluid narrative style shows that onset /l/'s do vary in backness, and suggests that backness is related to gestural timing. Backer onset /l/'s are usually longer, which means that Sproat and Fujimura’s notions of gestural affinity and gestural separation require modification. The tongue dorsum gesture for /l/ appears to avoid temporal overlap with a stressed vowel, whether or not that vowel is in the same syllable. The data also show, however, that longer /l/'s are not always backer: the relation of duration and backness can be complicated by differences in coarticulatory effects of neighboring vowels, or by speaker-specific constraints on absolute degree of backness. All of these contributing factors can be accommodated within a model of phonetic implementation sensitive to prosodic structure.

Objectives To examine the frequency of and factors predicting opioid resumption among patients with chronic non-cancer pain (CNCP) and therapeutic opioid addiction (TOA) treated in an interdisciplinary chronic pain rehabilitation program (CPRP) incorporating opioid weaning. Design Longitudinal retrospective treatment outcome study. Only those with addiction were counseled to avoid opioids for non-acute pain. Setting Large academic medical center. Participants One hundred twenty patients, 32.5% with TOA. Participants were predominately married (77.5%), females (66.7%). Mean age was 49.5 (±13.7). 29.2% had lifetime histories of non-opioid substance use disorders. Methods TOA was diagnosed using consensus definitions developed by American Academy of Pain Medicine, American Pain Society and American Society of Addiction Medicine to supplement Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) criteria. Non-opioid substance use disorders were diagnosed using DSM-IV-TR. Data, including pain severity, depression and anxiety, were collected at admission, discharge and 12 months. Opioid use during treatment was based on medical records and use at 12 months was based on self-report. Results Only 22.5% reported resuming use at 12 months. Neither patients with TOA nor patients with non-opioid substance use disorders were more likely to resume use than those without substance use disorders. Only posttreatment depression increased the probability of resumption. Conclusions CNCP and co-occurring TOA can be successfully treated within a CPRP. Patients report low rates of resumption regardless of addiction status. This is in marked contrast to reported outcomes of non-medically induced opioid addictions. Prolonged abstinence may depend upon the successful treatment of depression.