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BackgroundCurrent methods of burn estimation can lead to incorrect estimates of the total body surface area (TBSA) burned, especially among injured children. Inaccurate estimation of burn size can impact initial management, including unnecessary transfer to burn centres and fluid overload during resuscitation. To address these challenges, we developed a smartphone application (EasyTBSA) that calculates the TBSA of a burn using a body-part by body-part approach. The aims of this study were to assess the accuracy of the EasyTBSA application and compare its performance to three established methods of burn size estimation (Lund-Browder Chart, Rule of Nines and Rule of Palms).MethodsTwenty-four healthcare providers used each method to estimate burn sizes on moulaged manikins. The manikins represented different ages (infant, child and adult) with different TBSA burns (small 49%). We calculated the accuracy of each method as the difference between the user-estimated and actual TBSA. The true value of the complete body surface area of the manikins was obtained by three-dimensional scans. We used multivariable modelling to control for manikin size and method.ResultsAmong all age groups and burn sizes, the EasyTBSA application had the greatest accuracy for burn size estimation (−0.01%, SD 3.59%) followed by the Rule of Palms (3.92%, SD 10.71%), the Lund-Browder Chart (4.42%, SD 5.52%) and the Rule of Nines (5.05%, SD 6.87%).ConclusionsThe EasyTBSA application may improve the estimation of TBSA compared with existing methods.

We followed step by step the transition from an antiferromagnetic (AF) Mott insulator to a superconducting (SC) metal in the Bi$_2$Sr$_2$CaCu$_{2}$O$_{8+\delta}$ (Bi-2212) cuprate using the electronic Raman scattering spectroscopy. This was achieved by tracking the doping dependence of the spin singlet excitation originate from the AF Mott insulator, the normal state quasiparticles excitation related to the mobile charge carriers and the Bogoliubov quasiparticles related to the SC gap. We show that the signature of the pseudogap phase which develops during this transition, can be interpreted as the blocking of charge carriers by the enhancement of the antiferromagnetic correlations as the temperature drops. We find that the energy scale of the pseudogap, $\Delta_{\textrm{pg}}(p)$, closely follows the one of the spin singlet excitation, $\Delta_{\textrm{sse}}(p)$, with doping $p$. The quasiparticles lifetime considerably increases with doping when the pseudogap collapses. We reveal that the maximum amplitude of the SC gap, $\Delta_{\textrm{sc}}^{\textrm{max}}$ and the SC transition temperature \Tc are linked in an extended range of doping such as $\Delta_{\textrm{sc}}^{\textrm{max}}(p) \propto \Delta_{\textrm{sse}}(p)\, T_c(p)$. This relation suggests that the AF correlations play a key role in the mechanism of superconductivity., Comment: 9 pages, 6 figures

Until recently antimicrobial susceptibility testing (AST) methods based on the demonstration of phenotypic susceptibility in 16-24 h remained largely unchanged.Advances in rapid phenotypic and molecular-based AST systems.AST has changed over the past decade, with many rapid phenotypic and molecular methods developed to demonstrate phenotypic or genotypic resistance, or biochemical markers of resistance such as β-lactamases associated with carbapenem resistance. Most methods still require isolation of bacteria from specimens before both legacy and newer methods can be used. Bacterial identification by MALDI-TOF mass spectroscopy is now widely used and is often key to the interpretation of rapid AST results. Several PCR arrays are available to detect the most frequent pathogens associated with bloodstream infections and their major antimicrobial resistance genes. Many advances in whole-genome sequencing of bacteria and fungi isolated by culture as well as directly from clinical specimens have been made but are not yet widely available. High cost and limited throughput are the major obstacles to uptake of rapid methods, but targeted use, continued development and decreasing costs are expected to result in more extensive use of these increasingly useful methods.

Prehospital vital signs and the Glasgow Coma Scale score are often missing in clinical practice and not recorded in trauma databases. Our study aimed to identify factors associated with missing prehospital physiological values, including systolic blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, and Glasgow Coma Scale.We used our hospital trauma registry to obtain patient, injury, resuscitation, and transportation characteristics for injured children and adolescents (age15 y). We evaluated the association of missing documentation of prehospital values with other patient, injury, transportation, and resuscitation characteristics using multivariable regression. We standardized vital sign values using age-adjusted z-scores.The odds of a missing physiological value decreased with age (odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.9, 0.9) and were higher when prehospital cardiopulmonary resuscitation was required (OR = 3.3, 95% CI = 1.9, 5.7). Among the physiological values considered, we observed the highest odds of missingness of systolic blood pressure, respiratory rate, and oxygen saturation. The odds of observing normal emergency department physiological values were lower when prehospital physiological values were missing (OR = 0.9, 95% CI = 0.9, 1.0; P = 0.04).Missing prehospital physiological values were associated with younger age and cardiopulmonary resuscitation among the injured children treated at our hospital. Measurement and documentation of physiological variables of patients with these characteristics should be targeted.

Background Inconsistent trauma patient referral feedback limits trauma system growth and may perpetuate suboptimal care. Trauma and burn patients are transferred to our Level I pediatric trauma center from hospitals in the surrounding metropolitan area. In the past, we had no consistent method to address performance improvement opportunities or provide information on patient outcomes to the referring facilities. The purpose of this study is to describe the implementation and evaluation of a formal electronic transfer follow-up program. Methods This was a before-and-after quality improvement study of pediatric trauma patients comparing prefeedback program implementation (2018) to postfeedback program implementation (2019). A new transfer patient feedback program was designed to address low rates of feedback provided to referring hospitals. Our center worked with a software developer to create a program that stored outside hospital contacts, automated follow-up letters, and tracked the number of letters sent, and opened, to enhance communication between trauma center and referring facilities. Results A total of 383 preprogram (2018) patients and 369 postprogram (2019) patients were evaluated. Since program implementation, an average of 70% follow-up per referral and an average return rate of 45% have been maintained. Conclusion As we continue to use the system and make changes, we fully expect to exceed our goal in providing essential feedback on the care of pediatric trauma and burn patients to our referring facilities.

Objective To compare fixed-time artificial insemination (FTAI) conception rates and serum progesterone concentrations at the time of FTAI for cows treated with the original Ovsynch program (OV) with those treated with a modified Ovsynch (MO) program. Design This was a randomised clinical trial. Methods The study used five split-calving, pasture-based dairy herds in Southwest Victoria, Australia. Controls (n = 851) received the OV program: day 0 gonadotropin-releasing hormone, day 7 prostaglandin F2α (PGF), day 9 gonadotropin-releasing hormone and FTAI at day 10. The treatment group (n = 852) received a MO program with an additional prostaglandin injection on day 8. Subsets of cows from each group were sampled for blood progesterone at the time of FTAI. Results The treatment group demonstrated FTAI conception rates that were 7% (95% confidence interval 2%-12%) greater than the control group. After adjusting for the effect of age, days in milk at Mating Start Date and herd, the odds of conception using FTAI was 1.36 (95% confidence interval 1.12-1.66) times greater for treatment group cows compared with control group cows. The variability of serum progesterone concentrations at the time of FTAI was significantly less for treatment group cows compared with control group cows. Conclusion For Holstein-Friesian and Holstein-Friesian cross-bred cows managed in pasture-based dairy herds in southern Australia, a MO protocol, including a second injection of prostaglandin F2α on day 8, increased FTAI conception rates compared with cows receiving the OV protocol.

This paper presents a study of the lattice dynamics in BaFe

Emergency medical services clinicians do not transport one-third of all children assessed, even without official pediatric non-transport protocols. Little is known about how EMS clinicians and caregivers decide not to transport a child. Our objectives were to describe how EMS clinicians currently decide whether or not to transport a child and identify barriers to and enablers of successfully implementing an EMS clinician-initiated pediatric non-transport protocol. We conducted six virtual focus groups with EMS clinicians from the mid-Atlantic. A PhD trained facilitator moderated all groups using a semi-structured moderator guide. Multiple investigators independently coded a deidentified sample transcript. One team member then completed axial coding of the remaining transcripts. Thematic saturation was achieved. Clusters of similar codes were grouped into themes by consensus. We recruited 50 participants, of whom 70% were paramedics and 28% emergency medical technicians. There was agreement that caregivers often use 9-1-1 for low acuity complaints. Participants stated that non-transport usually occurs after shared decision-making between EMS clinicians and caregivers; EMS clinicians advise whether transport is necessary, but caregivers are responsible for making the final decision and signing refusal documentation. Subthemes for how non-transport decisions were made included the presence of agency protocols, caregiver preferences, absence of a guardian on the scene, EMS clinician variability, and distance to the nearest ED. Participants identified the following features that would enable successful implementation of an EMS clinician-initiated non-transport process: a user-friendly interface, clear protocol endpoints, the inclusion of vital sign parameters, resources to leave with caregivers, and optional direct medical oversight. EMS clinicians in our study agreed that non-transport is currently a caregiver decision, but noted a collaborative process of shared decision-making where EMS clinicians advise caregivers whether transport is indicated. Further research is needed to understand the safety of this practice. This study suggests there may be a need for EMS-initiated alternative disposition/non-transport protocols.

Introduction Current methods of burn estimation can lead to incorrect estimates of the total body surface area burned, especially among injured children. Inaccurate estimation of burn size can impact initial management, including unnecessary transfer to burn centers and fluid overload during resuscitation. To address these challenges, we developed a smartphone application that calculates the total body surface area of a burn using a body-part by body-part approach. The aims of this study were to assess the accuracy of the smartphone application and compare its performance to three established methods of burn size estimation (Lund-Browder Chart, Rule of Nines, Rule of Palms). Methods Twenty-four healthcare providers used each method to estimate burn sizes on moulaged manikins. The manikins represented different ages (infant, child, adult) with different total body surface area burns (small < 20%, medium 20-49%, large >49%). We calculated the accuracy of each method as the difference between the user-estimated and actual total body surface area. We used multivariable modeling to control for manikin size and method. Results Among all age groups and burn sizes, the smartphone application had the greatest accuracy for burn size estimation (-0.01%, SD 3.59%) followed by the Rule of Palms (3.92%, SD 10.71%), the Lund-Browder Chart (4.42%, SD 5.52%), and the Rule of Nines (5.05%, SD 6.87%). Conclusions The smartphone application may improve the estimation of total body surface area burned compared to existing methods.

Multilayered cuprates possess not only the highest superconducting temperature transition but also offer a unique platform to study disorder-free CuO

BackgroundMost pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain.ObjectiveThis study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention.MethodsAd spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays.ResultsWe created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; PConclusionsSocial media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message.

BACKGROUND Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain. OBJECTIVE This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention. METHODS Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays. RESULTS We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P CONCLUSIONS Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message.

Oxygen was electrochemically intercalated into Sr$_2$IrO$_4$ sintered samples, single crystals and a thin film. We estimate the diffusion length to a few $\mu$m and the concentration of the intercalated oxygen to $\delta$ $\simeq$ 0.01. The latter is thus much smaller than for the cuprate and nickelate parent compounds, for which $\delta$ $>$ 0.1 is obtained, which could be a consequence of larger steric effects. The influence of the oxygen doping state on resistivity is small, indicating also a poor charge transfer to the conduction band. It is shown that electrochemical intercalation of oxygen may also contribute to doping, when gating thin films with ionic liquid in the presence of water.

To compare fixed-time artificial insemination (FTAI) conception rates and serum progesterone concentrations at the time of FTAI for cows treated with the original Ovsynch program (OV) with those treated with a modified Ovsynch (MO) program.This was a randomised clinical trial.The study used five split-calving, pasture-based dairy herds in Southwest Victoria, Australia. Controls (n = 851) received the OV program: day 0 gonadotropin-releasing hormone, day 7 prostaglandin FThe treatment group demonstrated FTAI conception rates that were 7% (95% confidence interval 2%-12%) greater than the control group. After adjusting for the effect of age, days in milk at Mating Start Date and herd, the odds of conception using FTAI was 1.36 (95% confidence interval 1.12-1.66) times greater for treatment group cows compared with control group cows. The variability of serum progesterone concentrations at the time of FTAI was significantly less for treatment group cows compared with control group cows.For Holstein-Friesian and Holstein-Friesian cross-bred cows managed in pasture-based dairy herds in southern Australia, a MO protocol, including a second injection of prostaglandin F

Er_{2}Sn_{2}O_{7} remains a puzzling case among the extensively studied frustrated compounds of the rare-earth pyrochlore family. Indeed, while a first-order transition towards a long-range antiferromagnetic state with the so-called Palmer-Chalker structure is theoretically predicted, it has not yet been observed, leaving the issue as to whether it is a spin-liquid candidate open. We report on neutron scattering and magnetization measurements which evidence a second-order transition towards this Palmer-Chalker ordered state around 108 mK. Extreme care was taken to ensure a proper thermalization of the sample, which has proved to be crucial to successfully observe the magnetic Bragg peaks. At the transition, a gap opens in the excitations, superimposed on a strong quasielastic signal. The exchange parameters, refined from a spin-wave analysis in applied magnetic field, confirm that Er_{2}Sn_{2}O_{7} is a realization of the dipolar XY pyrochlore antiferromagnet. The proximity of competing phases and the strong XY anisotropy of the Er^{3+} magnetic moment might be at the origin of enhanced fluctuations, leading to the unexpected nature of the transition, the low ordering temperature, and the observed multiscale dynamics.

Background: Intravenous (IV) sedation analgesia is often employed in patients with chronic spinal pain undergoing diagnostic spinal injection procedures. The drugs used for intravenous sedation analgesia produce varying degrees of sedation, amnesia, anxiolysis, muscle relaxation, and analgesia. The very nature of these pharmacologic effects in altering the patient’s level of consciousness, awareness, or response to a particular diagnostic stimulus invokes a sense of uncertainty about the results or response obtained from the diagnostic procedure. There is an ongoing controversy regarding the validity of controlled diagnostic blocks due to variability in sensitivity, specificity, and accuracy. Moreover, there is no consensus with regards to the use of sedation analgesic measures prior to controlled diagnostic blocks and their influence on the accuracy and validity of a diagnosis. Objective: To assess and update the clinically significant effects sedation analgesia procedures have on the diagnostic accuracy and validity of interventional spinal techniques. Methods: A comprehensive literature search using PubMed, EMBASE, and Cochrane Library review databases up to September 2012 was performed. The search included systematic and narrative review articles, prospective and retrospective studies, as well as cross-referencing of bibliographies from notable primary and review articles and abstracts from scientific meetings and peer-reviewed non-indexed journals. The search emphasized the effects of sedation analgesia on diagnostic spinal interventions. Conclusion: Based on a review of the available evidence, it appears that the administration of mild to moderate sedation does not confound the results or diagnostic validity of spinal injection procedures. Specifically, immediate pain relief after cervical and lumbar facet joint controlled nerve blocks is not enhanced by IV sedation with midazolam or fentanyl. This is especially true if stringent outcome criteria are employed, such as at least 75% pain relief combined with an increase in range of motion for pain limited movements. Key words: Conscious sedation, procedural sedation, intravenous sedation, analgesia, hypnotics, sedatives, anxiolytics, opioids, chronic spinal pain, spinal injections, epidural injections, controlled diagnostic nerve blocks, zygapophyseal or facet joint blocks, selective nerve root blocks, provocation discography, sacroiliac joint injections, outcomes

Background: Post lumbar surgery syndrome refers to pain occurring or present after lumbar surgery. While the causes of pain after lumbar surgery are multi-factorial, scarring is a significant source of that pain. Low back and/or leg pain after lumbar surgery can persist despite appropriate conservative therapy. Spinal endoscopy allows direct visual evaluation of the epidural space, along with mechanical lysis of any adhesions present. Study Design: A systematic review of the effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome. Objective: To evaluate and update the effectiveness of spinal endoscopic adhesiolysis in treating post lumbar surgery syndrome. Methods: The available literature on spinal endoscopic adhesiolysis in treating post lumbar surgery syndrome was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Pain relief and functional improvement were the primary outcome measures. Other outcome measures were improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as improvement of 12 months or less; whereas, long-term effectiveness was defined 12 months or longer. Results: For this systematic review, 21 studies were identified. Of these, one randomized controlled trial (RCT) and 5 observational studies met the inclusion criteria. Two of the observational studies were excluded because of other methodological issues, despite showing positive outcomes. Using current criteria for successful outcomes, these studies indicate that there is fair evidence for the effectiveness of spinal endoscopy in the treatment of persistent low back and/or leg pain in post lumbar surgery syndrome. Limitations: The limitations of this systematic review include the paucity of literature. Conclusion: The evidence is fair that spinal endoscopy is effective in the treatment of post lumbar surgery syndrome. Key words: Spinal pain, chronic low back pain, post lumbar surgery syndrome, epidural scarring, adhesiolysis, endoscopy

The anisotropic magnetic properties of Sr2IrO4 are investigated, using longitudinal and torque magnetometry. The critical scaling across T(c) of the longitudinal magnetization is that expected for the 2D XY universality class. Modeling the torque for a magnetic field in the basal plane, and taking into account all in-plane and out-of-plane magnetic couplings, we derive the effective fourfold anisotropy K4 ≈ 1 × 10(5) erg mol(-1). Although larger than for the cuprates, it is found to be too small to account for a significant departure from the isotropic 2D XY model. The in-plane torque also allows us to set an upper bound for the anisotropy of a field-induced shift of the antiferromagnetic ordering temperature.

Repair of a retinal detachment was performed during a retrobulbar block with monitored anesthesia care and intravenous conscious sedation. Following the procedure and after removal of the sterile drapes, the patient exhibited significant swelling of the bilateral orbits, face, neck, and chest. Subcutaneous emphysema and pneumomediastinum were confirmed on postoperative chest radiographs and computed tomographic scans. Possible mechanisms and potential sequelae of this intraoperative event are discussed.

Background: The prevalence of cancer-related pain and residual pain in cancer survivors is high. Opioids serve as the gold standard for treating moderate to severe cancer pain. The evaluation of the effectiveness of opioids in chronic non-cancer pain has shown a lack of effectiveness, or rather weak evidence for some of the drugs. In contrast, in cancer pain, opioids are expected to be very effective. Due to the nature of the disease, there is evidence of a paucity of randomized trials investigating opioid effectiveness in cancer pain on a long-term basis. Consequently, the effectiveness of opioids in managing cancer-related pain warrants further evidence-based review beyond randomized trials, including observational studies and case reports. Methods: The comprehensive literature search was conducted for the period 1996 through June 2010. Databases for the search included PubMed, EMBASE, Cochrane Reviews, and clinicaltrails.gov, along with reviews and cross references. Methodologic quality assessment of the observational studies managing chronic cancer pain with opioids was conducted utilizing the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. Analysis of evidence included 5 levels of evidence developed by the United States Preventive Services Task Force (USPSTF) ranging from Level I to III with 3 subcategories in Level II. Grading recommendations were based on Guyatt et al’s recommendations with 6 levels: 3 in the strong category and 3 in the weak category. Results: This evaluation is of 18 manuscripts considered for inclusion; 7 manuscripts met the inclusion criteria based on AHRQ quality assessment. Level of evidence for opioid therapy in cancer pain was Level II-3, and recommendations were 1C/strong recommendation based on observational studies, which could change based on future evidence. Conclusion: This systematic review of observational studies indicates Level II3 evidence for effectiveness of opioids in cancer pain therapy, with 1C/strong recommendation based on observational studies, which could change based on future evidence. Key words: Chronic pain, cancer pain, non-cancer pain, randomized trials, observational studies, case reports, opioids, effectiveness

We study the temperature-dependent electronic B_{1g} Raman response of a slightly underdoped single crystal HgBa_{2}Ca_{2}Cu_{3}O_{8+δ} with a superconducting critical temperature T_{c}=122 K. Our main finding is that the superconducting pair-breaking peak is associated with a dip on its higher-energy side, disappearing together at T_{c}. This result reveals a key aspect of the unconventional pairing mechanism: spectral weight lost in the dip is transferred to the pair-breaking peak at lower energies. This conclusion is supported by cellular dynamical mean-field theory on the Hubbard model, which is able to reproduce all the main features of the B_{1g} Raman response and explain the peak-dip behavior in terms of a nontrivial relationship between the superconducting gap and the pseudogap.

We report electronic Raman scattering (ERS) measurements for a set of underdoped (p = 0.09–0.16) mercury-based HgBa2CuO4+δ (Hg-1201, T c max = 95 K ) cuprates. Inelastic light scattering (Raman effect) is a powerful experimental method for studying quasiparticles (QP) dynamics. Changing the polarization of incident and scattered light allows us to probe the QP dynamics in selected areas of the Fermi surface. By exploring the superconducting dome from the optimal doping to the underdoped one, we show unambiguously the existence of two distinct dynamics, respectively for the nodal (B2g symmetry) and the anti-nodal (B1g symmetry) QPs. As cuprates are underdoped, both an increasing of the amplitude and a loss of the intensity for the superconducting gap are observed, coherently with other charge spectroscopies such as ARPES or STM. On the contrary, the behavior of nodal QPs is totally different since the peak associated with the superconductivity in this symmetry follows Tc, and thus, shifts to the lower energies as we underdope the system. We finally show that these two features are only seen in the superconducting state.

Background: Facet joints are considered to be a common source of chronic spinal pain. Facet joint interventions, including intraarticular injections, medial branch nerve blocks, and neurotomy (radiofrequency and cryoneurolysis) are used to manage chronic facet-mediated spinal pain. A systematic review of therapeutic facet interventions published in January 2005, concluded that facet interventions were variably effective for short-term and long-term relief of facet joint pain. Objective: To provide an updated evaluation of the effectiveness of 3 types of facet joint interventions in managing chronic spinal pain. Study Design: A systematic review utilizing criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials and the Cochrane Musculoskeletal Review Group for randomized trials. Methods: Data sources included relevant literature of the English language identified through searches of MEDLINE and EMBASE (November 2004 to December 2006) and manual searches of bibliographies of known primary and review articles within the last 2 years. Results of the analyses were performed for the different modes of facet joint interventions for the cervical, thoracic and lumbar spine, to determine short- and long-term outcome measurements and complications associated with these procedures. Outcome Measures: The primary outcome measure was pain relief. For intraarticular facet joint injections and medial branch blocks, short-term pain relief was defined as relief lasting less than 6 weeks and long-term relief as 6 weeks or longer. For medial branch blocks, repeated injections at defined intervals provided long-term pain relief. For medial branch radiofrequency neurotomy, short-term pain relief was defined as relief lasting less than 3 months and long-term relief as lasting 3 months or longer. Other outcome measures included functional improvement, improvement of psychological status, and return to work. Results: For cervical intraarticular facet joint injections, the evidence is limited for short- and long-term pain relief. For lumbar intraarticular facet joint injections, the evidence is moderate for short- and long-term pain relief. For cervical, thoracic, and lumbar medial branch nerve blocks with local anesthetics (with or without steroids), the evidence is moderate for short- and longterm pain relief with repeat interventions. The evidence for pain relief with radiofrequency neurotomy of cervical and lumbar medial branch nerves is moderate for short- and long-term pain relief, and indeterminate for thoracic facet neurotomy. Conclusion: With intraarticular facet joint injections, the evidence for short- and long-term pain relief is limited for cervical pain and moderate for lumbar pain. For medial branch blocks, the evidence is moderate for short- and long-term pain relief. For medial branch neurotomy, the evidence is moderate for short- and long-term pain relief. Key words: Spinal pain, neck pain, low back pain, facet or zygapophysial joints, intraarticular facet joint injections, medial branch blocks, therapeutic medial branch blocks, radiofrequency neurotomy, cryodenervation.

Background: A 2-year review of literature from October 2004 to December 2006 was completed to update current scientific evidence on diagnostic utility of facet joint injections. Diagnostic injections are employed to diagnose facet joint pain because available techniques cannot identify the pain generating structure in patients with chronic spinal pain. There is no physical examination technique, laboratory test, or imaging modality that can precisely identify the spinal structure causing pain, distinguish the culprit from a variety of potential targets, and predict response to a therapeutic intervention. Zygapophysial joint injections, commonly called facet injections (intra-articular joint injections and medial branch blocks) are local anesthetic injections of the facet joint or its nerve supply. These are diagnostic procedures used to determine if pain is arising from facet joints, distinguish painful from nonpainful joints and prognosticate response to therapeutic facet joint interventions. Diagnostic injections must meet the cardinal features of a diagnostic test i.e., accuracy, safety, and reproducibility. Accuracy is based on comparison with a “gold standard” to confirm presence or absence of a disease. There is, however, no available gold standard to measure presence or absence of pain. Hence, there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections. Objectives: Evaluate and update available evidence (2004 to 2006) relating to clinical utility of facet joint injections (intraarticular and medial branch blocks) in diagnosing chronic spinal pain of facet joint origin. Study Design: Review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing facet joint pain according to Agency for Healthcare Research and Quality (AHRQ) and Quality Assessment Studies of Diagnostic Accuracy (QUADAS) criteria. The level of evidence was classified as conclusive (Level I), strong (Level II), moderate (Level III), or limited (Level IV). Methods: Computerized database search (2004 to 2006) of PUBMED, EMBASE, CINAHL, and Web of Knowledge was conducted to identify studies on facet joint pain and diagnostic interventions. Abstracts, reviews, book chapters, case reports, studies based on single blocks or blocks without radiologic control, and studies describing techniques were excluded. Prospective studies were given priority over retrospective studies. Results: There is no change in the strength of evidence for facet joint diagnostic injections. There is strong evidence for controlled comparative local anesthetic facet joint injections or medial branch blocks in the diagnosis of neck and low back pain and moderate evidence in the diagnosis of pain arising from thoracic facet joints. Conclusion: The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joints (medial branch or dorsal ramus) are reproducible, reasonably accurate and safe. The sensitivity, specificity, false-positive rates, and predictive values of these diagnostic tests for neck and low back pain have been validated and reproduced in multiple studies. Key words: Chronic spinal pain, neck pain, low back pain, cervical facet joint, thoracic facet joint, lumbar facet joint, zygapophyseal joint, medial branch block, intraarticular injection

We have studied multiferroic YMn2O5 by high-pressure neutron diffraction in a large pressure range from 0.5 to 6.3 GPa. We observe a pressure-induced commensurate (PCM) phase with a propagation vector ( 1 2 0 1 2 ) that is different from those observed at ambient pressure. It coexists with the ambient pressure phases up to the highest pressure, with an increased contribution as the pressure increases. The PCM phase, which is likely generic in the RMn2O5 family, should be taken into account to understand the strong variation of the electric polarization under pressure

We report a fine tuned doping study of strongly overdoped Bi_{2}Sr_{2}CaCu_{2}O_{8+δ} single crystals using electronic Raman scattering. Combined with theoretical calculations, we show that the doping, at which the normal-state pseudogap closes, coincides with a Lifshitz quantum phase transition where the active holelike Fermi surface becomes electronlike. This conclusion suggests that the microscopic cause of the pseudogap is sensitive to the Fermi surface topology. Furthermore, we find that the superconducting transition temperature is unaffected by this transition, demonstrating that their origins are different on the overdoped side.