Modeling the CO2-effects of forest management and wood usage on a regional basis

BACKGROUND: At the 15(th) Conference of Parties of the UN Framework Convention on Climate Change, Copenhagen, 2009, harvested wood products were identified as an additional carbon pool. This modification eliminates inconsistencies in greenhouse gas reporting by recognizing the role of the forest and timber sector in the global carbon cycle. Any additional CO(2)-effects related to wood usage are not considered by this modification. This results in a downward bias when the contribution of the forest and timber sector to climate change mitigation is assessed. The following article analyses the overall contribution to climate protection made by the forest management and wood utilization through CO(2)-emissions reduction using an example from the German state of North Rhine-Westphalia. Based on long term study periods (2011 to 2050 and 2100, respectively). Various alternative scenarios for forest management and wood usage are presented. RESULTS: In the mid- to long-term (2050 and 2100, respectively) the net climate protection function of scenarios with varying levels of wood usage is higher than in scenarios without any wood usage. This is not observed for all scenarios on short and mid term evaluations. The advantages of wood usage are evident although the simulations resulted in high values for forest storage in the C pools. Even the carbon sink effect due to temporal accumulation of deadwood during the period from 2011 to 2100 is outbalanced by the potential of wood usage effects. CONCLUSIONS: A full assessment of the CO(2)-effects of the forest management requires an assessment of the forest supplemented with an assessment of the effects of wood usage. CO(2)-emission reductions through both fuel and material substitution as well as CO(2) sink in wood products need to be considered. An integrated assessment of the climate protection function based on the analysis of the study’s scenarios provides decision parameters for a strategic approach to climate protection with regard to forest management and wood use at regional and national levels. The short-term evaluation of subsystems can be misleading, rendering long-term evaluations (until 2100, or even longer) more effective. This is also consistent with the inherently long-term perspective of forest management decisions and measures

Mechanisms of chiropractic spinal manipulative therapy for patients with chronic primary low back pain: Protocol for a mechanistic randomised placebo-controlled trial

Introduction Chronic low back pain (CLBP) is a highly prevalent and disabling condition. Identifying subgroups of patients afflicted with CLBP is a current research priority, for which a classification system based on pain mechanisms was proposed. Spinal manipulative therapy (SMT) is recommended for the management of CLBP. Yet, little data are available regarding its mechanisms of action, making it difficult to match this intervention to the patients who may benefit the most. It was suggested that SMT may influence mechanisms associated with central sensitisation. Therefore, classifying patients with CLBP according to central sensitisation mechanisms may help predict their response to SMT. Methods and analysis This protocol describes a randomised placebo-controlled trial aiming to examine which variables linked to central sensitisation may help predict the clinical response to SMT in a cohort of patients with CLBP. One hundred patients with chronic primary low back pain will be randomised to receive 12 sessions of SMT or placebo SMT over a 4-week period. Pain intensity and disability will be assessed as primary outcomes after completing the 4-week treatment (primary endpoint), and at 4-week and 12-week follow-ups. Baseline values of two pain questionnaires, lumbar pressure pain thresholds, concentrations of an inflammatory cytokine and expectations of pain relief will be entered as predictors of the response to SMT in a multiple regression model. Changes in these variables after treatment will be used in a second multiple regression model. The reference values of these predictors will be measured from 50 age and sex-matched healthy controls to allow interpretation of values in patients. Mixed analyses of variance will also be conducted to compare the primary outcomes and the predictors between groups (SMT vs placebo) over time (baseline vs post-treatment). Ethics and dissemination Ethical approval was granted by the Fundación Jiménez Díaz Clinical Research Ethics Committee. Trial registration number NCT05162924

Beneficial effects of manually assisted chiropractic adjusting instrument in a rabbit model of osteoarthritis.

Osteoarthritis (OA) is a degenerative disease characterized by injury of all joint tissues. Our previous study showed that in experimental osteoporosis, chiropractic manipulation (CM) exerts protective effects on bone. We here assessed whether CM might ameliorate OA by improving subchondral bone sclerosis, cartilage integrity and synovitis. Male New-Zealand rabbits underwent knee surgery to induce OA by anterior cruciate ligament injury. CM was performed using the chiropractic instrument ActivatorV 3 times/week for 8 weeks as follows: force 2 setting was applied to the tibial tubercle of the rabbit right hind limb (TM-OA), whereas the corresponding left hind limb received a false manipulation (FM-OA) consisting of ActivatorV firing in the air and slightly touching the tibial tubercle. After sacrifice, subchondral bone integrity was assessed in the tibiae by microCT and histology. Cartilage damage and synovitis were estimated by Mankin's and Krenn's scores, respectively, and histological techniques. Bone mineral density and content in both cortical and trabecular compartments of subchondral bone decreased in OA rabbits compared to controls, but partially reversed in the TM-OA group. Trabecular bone parameters in the latter group also showed a significant improvement compared to FM-OA group. Moreover RANKL, OPG, ALP and TRAP protein expression in subchondral bone significantly decreased in TM-OA rabbits with respect to FM-OA group. CM was associated with lower Mankin's and Krenn's scores and macrophage infiltrate together with a decreased protein expression of pro-inflammatory, fibrotic and angiogenic factors, in TM-OA rabbits with respect to FM-OA. Our results suggest that CM may mitigate OA progression by improving subchondral bone as well as cartilage and synovial membrane status.AODM was supported by grants from the Spanish Chiropractic Association (AEQ). AM was supported by grants from Spanish Ministry of Economy and Competitiveness and Carlos III Institute of Health (CP15/00053 and PI16/00991). We thank Dr. Carlos Guillén-Viejo (School of Pharmacy, Universidad Complutense de Madrid) for his help in advising in molecular biology methods. The authors are also grateful to Mark S. Davis for his assistance with editing and proofreading the article.S

Satisfacao dos profissionais e da comunidade com a estrategia da saude da familia

OBJETIVO: Analisar as limitações e os pontos positivos da Estratégia de Saúde da Família na perspectiva dos profissionais da saúde e da comunidade. MÉTODOS: Estudo realizado entre os meses de junho e agosto de 2009, na cidade de Vespasiano, MG, localizada na região Sudeste do Brasil. Para avaliar a Estratégia de Saúde da Família (ESF), foi aplicado questionário em 77 profissionais da saúde e 293 cuidadores de crianças menores de cinco anos. Variáveis como o treinamento das equipes de saúde, acesso da comunidade aos serviços prestados pelas equipes de ESF, comunicação com os pacientes, a atenção prestada à criança e as informações de saúde passadas aos cuidadores foram alguns dos pontos de interesse da investigação. Análises de regressão logística foram utilizadas para se avaliar a significância estatística das variáveis estudadas, bem como os valores de odds ratio e intervalo de confiança. RESULTADOS: A maioria dos profissionais relatou que seus treinamentos foram insuficientes em quantidade, conteúdo e metodologia utilizada. Os cuidadores e profissionais identificaram semelhantes limitações da Estratégia de Saúde da Família (os serviços inacessíveis à comunidade, falta de treinamento e número insuficiente de profissionais) e também pontos fortes semelhantes (a comunicação entre agentes comunitários e comunidade, fornecimento de informações educacionais e foco na atenção à criança). Como recomendações para a melhoria do programa foram apontados: a necessidade de mais médicos e especialistas, treinamentos em maior quantidade e qualidade e melhoria na marcação de consultas. A satisfação dos cuidadores foi relacionada aos benefícios ofertados, como as visitas dos profissionais às casas (OR 5,8; IC95% 2,8;12,1), boa relação entre comunidade e profissionais (OR 4,8; IC95% 2,5;9,3) e foco na saúde da família (OR 4,1; IC95% 1,6;10,2). Problemas como número insuficiente de profissionais (OR 0,3; IC95% 0,2;0,6), dificuldade de acesso aos serviços prestados pela ESF (OR 0,2; IC95% 0,1;0,4) e qualidade ruim dos serviços ofertados (OR 0,3; IC95% 0,1;0,6) foram relacionados à insatisfação da comunidade com a ESF. De uma maneira geral, a maioria dos cuidadores (62%) mostraram estar satisfeitos com os serviços prestados pela ESF. CONCLUSÕES: Identificar as limitações e os pontos positivos da ESF pode gerar uma valiosa informação, que auxiliará na melhoria dessa estratégia para a atenção primária no Brasil.OBJETIVO: Analizar las limitaciones y los puntos positivos de la Estrategia de Salud de la Familia en la perspectiva de los profesionales de la salud y de la comunidad. MÉTODOS: Estudio realizado entre los meses de Junio y Agosto de 2009, en la ciudad de Vespasiano, MG, localizada en el la región sureste de Brasil. Para evaluar la Estrategia de la Salud de la Familia (ESF), se aplicó cuestionario en 77 profesionales de la salud y 293 cuidadores de niños menores de cinco años. Las Variables, entrenamiento de los grupos de salud, acceso de la comunidad a los servicios suministrados por los grupos de ESF, comunicación con los pacientes, la atención suministrada al niño y las informaciones de salud entregadas a los cuidadores, fueron algunos de los puntos de interés de la investigación. Los análisis de regresión logística se utilizaron para evaluar la significancia estadística de las variables estudiadas, así como los valores de odds ratio (OR) e intervalo de confianza (IC). RESULTADOS: La mayoría de los profesionales mencionó que sus entrenamientos fueron insuficientes en cantidad, contenido y metodología utilizada. Los cuidadores y profesionales identificaron limitaciones semejantes de la ESF (los servicios inaccesibles a la comunidad, falta de entrenamiento e insuficiente número de profesionales) y también semejantes puntos fuertes (la comunicación entre agentes comunitarios y comunidad, suministro de informaciones educativas y énfasis en la atención del niño). Como recomendaciones para mejorar el programa fueron señalados: la necesidad de más médicos y especialistas, entrenamientos en mayor cantidad y calidad y mejoría al concertar cita con médicos. La satisfacción de los cuidadores fue relacionada con los beneficios ofertados, como las visitas de los profesionales a las casas (OR 5,8; IC95% 2,8;12,1), buena relación entre comunidad y profesionales (OR 4,8; IC95% 2,5;9,3) y, énfasis en la salud de la familia (OR 4,1; IC 95% 1,6; 10,2). Problemas como insuficiente número de profesionales (OR 0,3; IC95% 0,2;0,6), dificultad en el acceso a los servicios suministrados por la ESF (OR 0,2; IC95% 0,1;0,4) y mala calidad de los servicios ofertados (OR 0,3; IC95% 0,1;0,6) se relacionaron con la insatisfacción de la comunidad con la ESF. De una forma general, la mayoría de los cuidadores (62%) mostraron estar satisfechos con los servicios suministrados por la ESF. CONCLUSIONES: Identificar las limitaciones y los puntos positivos de la ESF puede generar una información valiosa que ayudará en la mejoría de ésta estrategia de atención primaria en Brasil.OBJECTIVE: To analyze the strengths and limitations of the Family Health Strategy from the perspective of health care professionals and the community. METHODS: Between June-August 2009, in the city of Vespasiano, Minas Gerais State, Southeastern Brazil, a questionnaire was used to evaluate the Family Health Strategy (ESF) with 77 healthcare professionals and 293 caregivers of children under five. Health care professional training, community access to health care, communication with patients and delivery of health education and pediatric care were the main points of interest in the evaluation. Logistic regression analysis was used to obtain odds ratios and 95% confidence intervals as well as to assess the statistical significance of the variables studied. RESULTS: The majority of health care professionals reported their program training was insufficient in quantity, content and method of delivery. Caregivers and professionals identified similar weaknesses (services not accessible to the community, lack of healthcare professionals, poor training for professionals) and strengths (community health worker-patient communications, provision of educational information, and pediatric care). Recommendations for improvement included: more doctors and specialists, more and better training, and scheduling improvements. Caregiver satisfaction with the ESF was found to be related to perceived benefits such as community health agent household visits (OR 5.8, 95%CI 2.8;12.1), good professional-patient relationships (OR 4.8, 95%CI 2.5;9.3), and family-focused health (OR 4.1, 95%CI 1.6;10.2); and perceived problems such as lack of personnel (OR 0.3, 95%CI 0.2;0.6), difficulty with access (OR 0.2, 95%CI 0.1;0.4), and poor quality of care (OR 0.3, 95%CI 0.1;0.6). Overall, 62% of caregivers reported being generally satisfied with the ESF services. CONCLUSIONS: Identifying the limitations and strengths of the Family Health Strategy from the healthcare professional and caregiver perspective may serve to advance primary community healthcare in Brazil

Clinical effectiveness and efficacy of chiropractic spinal manipulation for spine pain

Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists. The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be provided. In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT

Reactions to geovisualization: An experience from a European project

The paper is written jointly by two parties, computer scientists specializing in geovisualization and experts in forestry, who cooperated within a joint project. The authors tell a story about an attempt of the geovisualizers to introduce the foresters to the concept and principles of exploratory data analysis and to the use of visualization for systematic and comprehensive data exploration. This endeavor should be considered as an informal experiment rather than a rigorous scientific study. Unlike customary tests of the usability of specific tools and techniques, the geovisualizers did not give the forestry specialists a series of tasks to carry out by applying geovisualization tools and did not try to measure how well the foresters performed. The idea of the geovisualizers was to demonstrate the principles and power of exploratory data analysis to the foresters by example. For this purpose, the geovisualizers performed an exploration of a non‐trivial data set by themselves and reported the procedure, the principles, the techniques, and the findings to the foresters. The reaction of the foresters uncovered a range of fundamental issues that are relevant to geovisualization and information visualization research. The authors analyze these issues from their perspectives and formulate a set of questions which researchers in geovisualization should be asking

Chiropractic spinal manipulation prevents secondary hyperalgesia induced by topical capsaicin in healthy individuals

Background and Aims: Spinal manipulation (SM) is currently recommended for the management of back pain. Experimental studies indicate that the hypoalgesic mechanisms of SM may rely on inhibition of segmental processes related to temporal summation of pain and, possibly, on central sensitization, although this remains unclear. The aim of this study was to determine whether experimental back pain, secondary hyperalgesia, and pain-related brain activity induced by capsaicin are decreased by segmental SM. Methods: Seventy-three healthy volunteers were randomly allocated to one of four experimental groups: SM at T5 vertebral level (segmental), SM at T9 vertebral level (heterosegmental), placebo intervention at T5 vertebral level, or no intervention. Topical capsaicin was applied to the area of T5 vertebra for 40 min. After 20 min, the interventions were administered. Pressure pain thresholds (PPTs) were assessed outside the area of capsaicin application at 0 and 40 min to examine secondary hyperalgesia. Capsaicin pain intensity and unpleasantness were reported every 4 min. Frontal high-gamma oscillations were also measured with electroencephalography. Results: Pain ratings and brain activity were not significantly different between groups over time (p > 0.5). However, PPTs were significantly decreased in the placebo and control groups (p < 0.01), indicative of secondary hyperalgesia, while no hyperalgesia was observed for groups receiving SM (p = 1.0). This effect was independent of expectations and greater than placebo for segmental (p < 0.01) but not heterosegmental SM (p = 1.0). Conclusions: These results indicate that segmental SM can prevent secondary hyperalgesia, independently of expectations. This has implications for the management of back pain, particularly when central sensitization is involved