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Long-distance translocation (LDT), the relocation of an animal outside of its home range, is a popular strategy for mitigating conflict between humans and venomous snakes. While LDT has been demonstrated to prevent a snake’s return to the location of capture, it may result in increased mortality, magnitude and frequency of movements, and activity range sizes. Thus, it has generally been discouraged. However, the effects of LDT on stress physiology and thermoregulation have gone largely unstudied in reptiles. To elucidate these effects, we conducted an experimental LDT on Western Rattlesnakes (Crotalus oreganus) on Vandenberg Air Force base in California. Fourteen snakes were monitored, beginning in mid July 2012 and ending in early September. Each was implanted with a radio transmitter and iButton temperature data logger within the coelomic cavity. In late August, seven snakes were translocated to similar habitat, approximately 30 kilometers away, where they were monitored for 9-13 days. Prior to translocation, all snakes were tracked every other day, while after translocation all snakes were tracked every day. A ‘Before-After Control-Impact’ (BACI) experimental design was used, with a dedicated control group, but also with the translocated group serving as control prior to the act of translocation. We collected data on snake body temperatures (T­b) and temperatures (T­e) of physical operative temperature models (OTMs) that simulated non-thermoregulating snakes and allowed for a comparison of habitat thermal quality between our two study sites. Together, T­b and T­e allowed for a formal assessment of thermoregulatory effectiveness. Additionally, blood concentrations of corticosterone (CORT), the primary stress hormone in reptiles, and testosterone (T), a metric of male reproductive ability that is often negatively associated with CORT, were assayed just prior to translocation and again at the end of the study. During each of the two sampling periods, in addition to baseline hormone concentrations, stressed hormone concentrations were assayed following the application of an acute stressor (the baseline blood draw plus one hour’s captivity in a plastic bucket). We also studied the effect of LDT on the CORT and T response (stressed concentration minus baseline concentration). Furthermore, we evaluated how LDT impacted a suite of behaviors related to defense and movement, as well as snake body mass and body condition index (BCI). Finally, we assessed the effects of LDT on movements and spatial use (activity range size). We sought to assess the effects of LDT on movements, spatial use, and behavior in order to facilitate comparison with other translocation studies, as well as to evaluate those impacts in a physiological context. In addition to assessing the impact of LDT on CORT and T separately, we evaluated a relationship between the two steroid hormones, and, using a model selection approach, we evaluated relationships between CORT and T and movements and spatial use. The thermal quality of the habitat at our two sites did not differ and we found no effect of LDT on snake body temperature or thermoregulatory effectiveness. We found that spatial use increased following LDT, since the average 100% minimum convex polygon (MCP) activity range size of our translocated snakes was greater than that of our control snakes during the post-translocation period. However, movements (mean distance moved per day and total distance moved) were unaffected by LDT. Translocation was not found to affect snake body mass or BCI, indicating that snake energy demands did not increase as a result of LDT. Of the behaviors that we recorded, many (rattling, tongue-flicking, fleeing, moving vs. stationary when found) were observed too infrequently to carry out satisfactory parametric analyses, though a qualitative assessment leads to the conclusion that LDT did not affect them. The effect of LDT on how often our snakes were visible was marginally significant, but post-hoc testing found no differences. Nonetheless, the translocated snakes tended to be visible more often than the controls, during the post-translocation period. We found no effect of LDT on the percentage of a snake’s body sunlit when visible. Our translocation was not found to any CORT metric, while for T, the only metric that was affected was the baseline concentration. Baseline T was found to be higher in translocated snakes than in control snakes following translocation. We found some evidence for a positive relationship between CORT and T for baseline and stressed concentrations. Our model selection procedure found little evidence for a relationship between snake movements and spatial use and either CORT or T. Our results are encouraging in that we did not find that LDT disrupts thermoregulation or results in a condition of chronic stress, as indicated by the CORT results. The positive effect of LDT on baseline T is somewhat mysterious, but studies on mammals suggest that increased T may aid in spatial learning and memory. Since the site that a snake is translocated to is entirely novel, an elevated capacity for spatial learning and memory could be beneficial to a translocated snake. Our finding that spatial use increased following LDT agrees with other studies of LDT in snakes, but some studies have found that movements increased following LDT, while we did not. In addition to snake movements being unaffected, we translocated our snakes within a relatively thermally benign climate in coastal central California. Translocations carried out in more extreme climates, with either cold winters or hot summers may indeed result in an effect on thermoregulation and a state of chronic stress. Consequently, we advocate further study of the physiological effects of LDT on other snake species in a variety of climates. Additionally, while it was our goal to study the short-term effects of LDT, more long-term studies, which follow the snakes through the entire active season and the winter hibernation period, may be informative.

Chronic low back pain (CLBP) is a critical public health issue and affects a significant number of people physically, emotionally, and financially. There is evidence that pain may affect one’s perception of time, but more work is needed to understand how different types of pain (acute, chronic) impact temporal perception. This study aimed to examine how acute experimental pain and CLBP, together and separately, impact the perception of time. A sample of 77 participants, 10 with CLBP and 67 healthy pain-free controls, completed two temporal perception tasks (Bisection and Threshold) twice, once with induced acute pressure pain and once without pain. The effects of acute pain and CLBP on temporal perception were examined using repeated measures ANOVAs. Results showed that the presence of either acute or chronic pain was related to overestimating time during shorter stimuli presentations and underestimating time during longer stimuli presentations. Further, subjects with chronic pain generally required a longer time difference to accurately distinguish between stimuli of differing lengths. This study demonstrates that both acute and chronic pain affect temporal perception, though the combination of acute and chronic pain does not confer additive adverse effects. The results of this study broaden our understanding of the impact of different types of pain on a person’s perception of time. / 2025-02-03T00:00:00Z

BACKGROUND: Chronic pain is prevalent among millions of Americans and can negatively impact cognitive processes, mental health, and overall quality of life. Even though pain affects all ethnic and racial groups equally, studies have shown a growing disparity in pain intensity and prevalence of pain conditions among underrepresented minority adult populations across the United States. Hispanics are among the fastest-growing populations in the U.S., yet chronic pain in Hispanic adults and adolescents remains severely understudied. PURPOSE: This study aims to compare pain and related psychosocial factors (pain catastrophizing, anxiety and depression) and Fear of Pain Questionnaire scores (FOPQ) in Hispanic vs. Non-Hispanic White (NHW) youth with chronic pain. Based on prior literature from studies in adults, it was hypothesized that Hispanic youth would report greater pain catastrophizing, anxiety, depression, and higher FOPQ scores when compared to NHW youth. Further, potential differences in relations between anxiety, pain catastrophizing, and physical functioning on depression among Hispanic and NHW youth will be explored. METHODS: Participant data were gathered from the Boston Children’s Hospital Chronic Pain Data Repository. The current study sample included 116 children and adolescents, ages 12-18 years (M = 15.49, SD = 1.71) from Hispanic and NHW backgrounds. Both groups had the same proportion of participants who identified as female (88%), and samples used for analysis were age-and-sex matched. Independent sample t-tests were performed to compare the mean differences in pain catastrophizing, PROMIS anxiety and depression scores, and FOPQ sum score between groups. Bivariate correlations for each group were also compared, and Hayes PROCESS Macro was used to compare the associations between pain catastrophizing, anxiety, and physical functioning on depression, based across patient ethnicities. RESULTS: The results of independent samples t-tests did not reveal any significant differences across groups. However, significant correlations were found. Notably, PROMIS anxiety and depression t-scores were significantly correlated among each independent cohort of Hispanic youth (r = .612, p <.001), non-Hispanic White youth (r = .817, p<.001), and across the full sample (r = .719, p <.001). Pain catastrophizing was also found to be significantly and positively correlated with anxiety (r = .660, p<.001), depression (r = .582, p <.001) and patient FOPQ score (r = .740, p <.001) across both cohorts. From the moderation analysis, the association between pain catastrophizing and depression was found to be statistically significant based on ethnicity of patient [B = .0272, p<.05]. Similarly, ethnicity was found to significantly moderate the association between PROMIS anxiety and depression [B = .0340, p<.05]. CONCLUSIONS: This study is one of the first to explore how pain and psychosocial-related factors compare in an age-and-sex-matched cohort of Hispanic vs. NHW youth with chronic pain. The study is also novel in identifying patient ethnicity as a moderator between anxiety and pain catastrophizing on depression. Obtaining a significant correlation between pain catastrophizing, anxiety, and depression scores for both groups parallels previous findings in adult populations with chronic pain. Contrary to our hypotheses, no mean differences were found in variables associated with pain or psychosocial factors between the two groups, however it is possible that the small sample size used may have obscured group differences. The results highlight the need to increase diversity in research for pediatric populations with chronic pain to help reduce pain disparities among underrepresented minority youth populations.

Chronic pain (CP) is a personal and economic burden that affects more than 30% of the world's population. While being the leading cause of disability, it is complicated to diagnose and manage. The optimal way to treat CP is to identify the pain mechanism or the underlying cause. The substantial overlap of the pain mechanisms (i.e., Nociceptive, Neuropathic, and Nociplastic) usually makes identification unreachable in a clinical setting where finding the dominant mechanism is complicated. Additionally, many specialists regard CP classification as a spectrum or continuum. Despite the importance, a data-driven way to identify co-existing CP mechanisms and quantification is still absent. This work successfully identified the co-existing CP mechanisms within a patient using Unsupervised Learning while quantifying them without the help of diagnosis established by the clinicians. Two different datasets from different cohorts comprised of patient-reported history and questionnaires were used in this work. Unsupervised Learning (k-prototypes) revealed notable overlaps in the data. It was further emphasized by the outcomes of the Semi-supervised Learning algorithms when the same trend was observed with some diagnosis or class information. It became evident that the CP mechanisms overlap and cannot be classified as distinct conditions. Additionally, mixed pain mechanisms do not make an individual cluster or class, and CP should be considered as a continuum. To reduce data dimension and extract hidden features, Autoencoder was used. Using an overlapping clustering technique, the pain mechanisms were identified. The pain mechanisms were also quantified while elucidating overlaps, and the dominant CP mechanism was successfully pointed out with explainable element. The hamming loss of 0.43 and average precision of 0.5 were achieved when considered as a multi-label classification problem. This work is a data-driven validation that there are significant overlaps in CP conditions, and CP should be considered a continuum where all CP mechanisms may co-exist. / Thesis / Master of Applied Science (MASc) / Chronic pain (CP) is a global burden and the primary cause for patients to seek medical attention. Despite continuous efforts in this area, CP remains clinically challenging to manage. The most effective method of treating CP is identifying the underlying cause or mechanism, which is often unattainable. This thesis attempted to identify the CP mechanisms existing in a patient while quantifying them from patient-reported history and questionnaire data. Unsupervised Learning was used to identify clinically meaningful clusters that revealed the three main CP mechanisms, i.e., Nociceptive, Neuropathic, and Nociplastic, achieving acceptable hamming loss (0.43) and average precision (0.5). The results exhibited that the CP mechanisms co-exist and CP should be regarded as a continuum rather than distinct entities. The algorithm successfully indicated the dominant CP mechanism, a goal for optimal CP management and treatment. The results were also validated by a comparative analysis with data from another cohort that demonstrated a similar trend.

It has been estimated that by the year 2014 there will be a 12 per cent increase in the number of adults with at least one chronic illness condition (Carrier, 2009). The turn to caring for those with a chronic illness at home has resulted in carers having an increased risk of developing health problems (Ohman & Soderberg, 2004). As such there is a need to understand how families manage and cope with illness at home. This study has examined the effect chronic illness had on not only the woman with illness, but also the immediate family closely involved with her care. Additionally the study has sought to address the effect chronic illness had on the ¿self¿ and ¿identity¿ of these three women and to determine what extent and impact the illness process had on the relationships within this family. The study used open-ended biographic narrative interviews to elicit data. The research revealed that each woman experienced change and loss to both ¿self¿ and ¿identity¿ albeit in different ways. Interestingly and of significance is the way these women in their narrative accounts revisited their past lives in implicating and accounting for the present and the future (Freeman 2010). It was discovered that the past history and past relationships of these women affected how they each responded to illness and each other in their present circumstances.

Chronic pain is one of the most frequent reasons for a primary health care visit and people with pain identify improved function as an important goal. Self-management support provides an opportunity to improve function for people with chronic pain, but existing evidence suggests negligible changes in function. This thesis includes five manuscripts with overarching objectives of improving the understanding of reductions in function related to pain and evaluating a new self-management program aimed at improving function for people with chronic pain. The first manuscript is a cross-sectional evaluation of factors associated with reduced function in people with chronic pain referred for self-management support in primary health care. The findings suggest number of medications, depressive symptoms, cognitive factors associated with pain, mechanical hyperalgesia, and duration of symptoms explain 63% of the variance in function in people with chronic pain, multiple comorbidities, and barriers to accessing healthcare. The second manuscript is a case-series describing the participation and outcomes of six participants in Chronic pain self-management support with pain science education and exercise (COMMENCE). This study contributes to the literature by detailing the COMMENCE intervention and describing the varied responses of six participants. The third and fourth manuscripts are a protocol for a randomized controlled trial (RCT) and a completed RCT evaluating the effectiveness of COMMENCE in comparison to a wait-list control. The results suggest COMMENCE improves function for people with chronic pain (mean difference = -8.0 points on the Short Musculoskeletal Function Assessment; 95% confidence interval: -14.7 to -1.3). The fifth manuscript is a planned secondary analysis of the RCT described above. This study suggested people with a greater number of comorbidities are likely to have poorer function at the end of COMMENCE after controlling for age, gender, and baseline function. Together, these factors explained 63% of the variance in function. / Thesis / Doctor of Philosophy (PhD) / Chronic pain is associated with suffering, disability, and health care costs. This thesis includes five papers aimed at better understanding reduced function and evaluating a new self-management program for people living with chronic pain. The results of this research suggests people with more medications, longer lasting pain, negative thoughts and emotions related to their pain, and sensitivity to pressure are more likely to have poor functional abilities. A new self-management approach, Chronic pain self-management support with pain science education and exercise (COMMENCE), is described and evaluated. The results suggest people with chronic pain participating in COMMENCE experience greater improvements in function than people on a wait-list for the program. It appears people living with more chronic health conditions are likely to have poorer function at the end of the program. The findings of this thesis may help to inform management of chronic pain in primary healthcare.

Background and objectives: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic condition defined by an increase in cardiovascular calcifications and bone fragility. The condition is diagnosed by abnormal serum concentrations of calcium, phosphorus, parathyroid hormone and vitamin D. These biochemical abnormalities have been linked to abnormal bone metabolism as well as cardiovascular calcifications if left untreated. Phosphate binders are known to cause phosphate reduction through mechanisms involve the gastrointestinal route. Their relative effects remain uncertain. Controversy arises because of concerns related to systematic effects, tolerability, costs and impact on patient important outcomes. The objective of Chapters 2 and 3 was to explore the relative effectiveness of phosphate binders on patient-important outcomes and laboratory outcomes in patients with CKD-MBD using the frequentist and Bayesian approaches, respectively. The purpose of Chapter 4 was to critically appraise clinical practice guidelines addressing CKD-MBD. Methods and results Chapter 2: We performed network meta-analyses for all cause-mortality for individual agents (seven-node analysis) and conventional meta-analysis of calcium vs. non-calcium based phosphate binders (NCBPB) for all-cause mortality, cardiovascular mortality and hospitalization. Our results suggested higher mortality with calcium than either sevelamer in our network meta-analysis or NCBPB in our conventional meta-analysis. Conventional meta-analysis suggested no statistically difference in cardiovascular mortality between calcium and NCBPBs. Chapter 3: We performed Bayesian network meta-analyses to calculate the effect estimates (mean differences) and 95% credible intervals for serum levels of phosphate, calcium and parathyroid hormone. Moderate-quality evidence suggests superior effect of active treatment categories as compared to placebo for reducing serum phosphate. Our NMA results did not find statistically significant difference between active treatment categories in lowering serum phosphate. Chapter 4: We performed a systematic survey to critically appraise clinical practice guidelines addressing CKD-MBD. Most guidelines assessing CKD-MBD suffer from serious shortcomings using the Advancing Guideline Development, Reporting and Evaluation in Health Care instrument II (AGREE) criteria; a minority, however, fulfill the criteria. Limitations with respect to AGREE criteria do not, however, necessarily lead to inappropriate recommendations. Conclusion: Given the likely mortality reduction with sevelamer versus calcium, the results suggest that higher calcium levels associated with calcium based phosphate binders may contribute to the mortality differential. We found that most clinical practice guidelines related to CKD-MBD were not satisfactory with major problems with rigor, update and implementation. Recommendations were consistent and thus unassociated with guideline quality. In other instances, however, this may not be the case, and ensuring trustworthiness of guidelines will require adherence to methodological standards. / Thesis / Doctor of Philosophy (PhD)

Thesis advisor: Lisa Wood Magee / Background: Chronic cancer-related pain is a considerable problem in cancer survivors. The incidence of chronic pain in cancer survivors is nearly double the rate in the general population. Chronic cancer-related pain reduces quality of life and results in higher healthcare utilization. Due to a lack of alternative treatments, the management of chronic cancer-related pain relies on a biomedical model, with opioids being the cornerstone of cancer-related pain management. As concerns about the risks of long-term opioid therapy rise, there is a need to understand the factors that influence chronic cancer-related pain experience. This manuscript dissertation aims to answer the overarching question, “What are the unique factors that inform the chronic cancer-related pain experience in cancer survivors?” Methods: First, an integrative review aimed to examine the evidence of long-term opioid use in cancer-survivors. Next, a qualitative study using descriptive phenomenology was conducted to develop a deeper understanding of the daily lived experience of chronic cancer-related pain. And finally, a prospective cross-section quantitative study was completed to quantify the contribution of unique cancer-specific factors to the chronic cancer-related pain experience in cancer survivors. Results: The integrative review shed light on the biopsychosocial factors associated with the transition to long-term opioid therapy (LTOT), including the role of cancer type, medical comorbidities, mental health diagnoses, and socioeconomic factors. No studies examined pain severity, pain interference, or cancer-specific psychosocial factors in cancer survivors prescribed LTOT. Second, cancer survivors describe living with chronic cancer-related pain as the cost of survival. Yet, their suffering was often invisible to others. The role of opioids in chronic cancer-related pain leads to strained communication with clinicians and the need to self-navigate a treatment plan characterized by ‘trying everything’. And finally, select cancer-specific psychosocial factors explained relatively little variance in the pain experience compared to non-cancer specific factors of multisite pain and pain catastrophizing. Conclusions: The constellation of the finding from this body of work demonstrates unique factors that inform the chronic cancer-related pain experience in cancer survivors, and several areas of overlap with other chronic pain syndromes. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.