Physiotherapy for Patients with Sciatica Awaiting Lumbar Micro-discectomy Surgery: A Nested, Qualitative Study of Patients' Views and Experiences

Background and Purpose Sciatica is a common clinical condition that can be extremely painful, disabling and life‐changing. Whether conservative or surgical treatment for sciatica secondary to an intervertebral disc prolapse is most effective is still much debated. An important component of conservative treatment is physiotherapy, which aims to promote physical and psychological health for the patient, whilst resorption of the disc takes place. This paper reports a qualitative study of patients' views and experiences of a bespoke physiotherapy intervention for the treatment of sciatica. Methods A qualitative study nested within a pilot randomized controlled trial of bespoke physiotherapy for the treatment of patients with sciatica awaiting lumbar microdiscectomy surgery. Patients randomized to receive bespoke physiotherapy in the intervention arm of the trial were invited to take part in semi‐structured interviews. Twenty‐one in‐depth, semi‐structured interviews took place. All interviews were recorded, fully transcribed and thematically analysed. Results Most patients in the sample found the physiotherapy valuable, appreciating the individual nature of the approach, the exercises to reduce pain and discomfort, techniques for improving functional spinal movement, walking and dynamic posture, and manual therapy and cardiovascular exercise. A small number did not find the physiotherapy of benefit. Sixteen patients in the sample went on to proceed with surgery, but most of these found value in having had the physiotherapy first. Discussion Many patients with sciatica appreciate the value of physiotherapy prior to surgery. Future research should examine patients' experiences of bespoke physiotherapy delivered within primary care

Preventing and lessening exacerbations of asthma in school-age children associated with a new term (PLEASANT) : Study protocol for a cluster randomised control trial

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedBackground: Within the UK, during September, there is a pronounced increase in the number of unscheduled medical contacts by school-aged children (4-16 years) with asthma. It is thought that that this might be caused by the return back to school after the summer holidays, suddenly mixing with other children again and picking up viruses which could affect their asthma. There is also a drop in the number of prescriptions administered in August. It is possible therefore that children might not be taking their medication as they should during the summer contributing to them becoming ill when they return to school. It is hoped that a simple intervention from the GP to parents of children with asthma at the start of the summer holiday period, highlighting the importance of maintaining asthma medication can help prevent increased asthma exacerbation, and unscheduled NHS appointments, following return to school in September.Methods/design: PLEASANT is a cluster randomised trial. A total of 140 General Practices (GPs) will be recruited into the trial; 70 GPs randomised to the intervention and 70 control practices of "usual care" An average practice is expected to have approximately 100 children (aged 4-16 with a diagnosis of asthma) hence observational data will be collected on around 14000 children over a 24-month period. The Clinical Practice Research Datalink will collect all data required for the study which includes diagnostic, prescription and referral data.Discussion: The trial will assess whether the intervention can reduce exacerbation of asthma and unscheduled medical contacts in school-aged children associated with the return to school after the summer holidays. It has the potential to benefit the health and quality of life of children with asthma while also improving the effectiveness of NHS services by reducing NHS use in one of the busiest months of the year. An exploratory health economic analysis will gauge any cost saving associated with the intervention and subsequent impacts on quality of life. If results for the intervention are positive it is hoped that this could be adopted as part of routine care management of childhood asthma in general practice. Trial registration: Current controlled trials: ISRCTN03000938 (assigned 19/10/12) http://www.controlled-trials.com/ISRCTN03000938/.UKCRN ID: 13572.Peer reviewe

Lead halide perovskites: Challenges and opportunities in advanced synthesis and spectroscopy

Hybrid lead perovskites containing a mixture of organic and inorganic cations and anions have led to solar cell devices with performance and stability that are better than those of their single-halide analogs. 207Pb solid-state nuclear magnetic resonance and single-particle photoluminescence spectroscopies show that the structure and composition of mixed-halide and likely other hybrid lead perovskites are much more complex than previously thought and are highly dependent on their synthesis. While a majority of reports in the area focus on the construction of photovoltaic devices, this Perspective focuses instead on achieving a better understanding of the fundamental chemistry and photophysics of these materials, because this will aid not only in constructing improved devices but also in generating new uses for these unique materials

The CROPGRO Perennial Forage Model Simulates Productivity and Re-Growth of Tropical Perennial Grasses

This paper introduces the CROPGRO Perennial Forage model (CROPGRO-PFM) and describes its ability to simulate regrowth dynamics and herbage production of Brachiaria and Panicum as affected by harvest management and weather. The model simulates regrowth, herbage harvests, percent leaf, and herbage protein of perennial forage grasses and legumes over multiple seasons. It can regrow from zero LAI (after harvest) based on use of carbohydrate and N reserves in storage tissues; however, the amount of residual stubble and residual leaf area index (LAI) are also important for rapid regrowth and productivity. The model is publically available for download from DSSAT.NET

Morphometric, hemodynamic, and biomechanical factors influencing blood flow and oxygen concentration in the human lamina cribrosa

Purpose: We developed a combined biomechanical and hemodynamic model of the human eye to estimate blood flow and oxygen concentration within the lamina cribrosa (LC) and rank the factors that influence LC oxygen concentration. Methods: We generated 5000 finite-element eye models with detailed microcapillary networks of the LC and computed the oxygen concentration of the lamina retinal ganglion cell axons. For each model, we varied the intraocular pressure (IOP) from 10 mm Hg to 55 mm Hg in 5-mm Hg increments, the cerebrospinal fluid pressure (13 ± 2 mm Hg), cup depth (0.2 ± 0.1 mm), scleral stiffness (±20% of the mean values), LC stiffness (0.41 ± 0.2 MPa), LC radius (1.2 ± 0.12 mm), average LC pore size (5400 ± 2400 µm2), the microcapillary arrangement (radial, isotropic, or circumferential), and perfusion pressure (50 ± 9 mm Hg). Blood flow was assumed to originate from the LC periphery and drain via the central retinal vein. Finally, we performed linear regressions to rank the influence of each factor on the LC tissue oxygen concentration. Results: LC radius and perfusion pressure were the most important factors in influencing the oxygen concentration of the LC. IOP was another important parameter, and eyes with higher IOP had higher compressive strain and slightly lower oxygen concentration. In general, superior–inferior regions of the LC had significantly lower oxygen concentration than the nasal–temporal regions, resulting in an hourglass pattern of oxygen deficiency. Conclusions: To the best of our knowledge, this study is the first to implement a comprehensive hemodynamical model of the eye that accounts for the biomechanical forces and morphological parameters of the LC. The results provide further insight into the possible relationship of biomechanical and vascular pathways leading to ischemia-induced optic neuropathy

Climate Impacts on Agriculture: Implications for Crop Production

Changes in temperature, CO2, and precipitation under the scenarios of climate change for the next 30 yr present a challenge to crop production. This review focuses on the impact of temperature, CO2, and ozone on agronomic crops and the implications for crop production. Understanding these implications for agricultural crops is critical for developing cropping systems resilient to stresses induced by climate change. There is variation among crops in their response to CO2, temperature, and precipitation changes and, with the regional differences in predicted climate, a situation is created in which the responses will be further complicated. For example, the temperature effects on soybean [Glycine max (L.) Merr.] could potentially cause yield reductions of 2.4% in the South but an increase of 1.7% in the Midwest. The frequency of years when temperatures exceed thresholds for damage during critical growth stages is likely to increase for some crops and regions. The increase in CO2 contributes significantly to enhanced plant growth and improved water use efficiency (WUE); however, there may be a downscaling of these positive impacts due to higher temperatures plants will experience during their growth cycle. A challenge is to understand the interactions of the changing climatic parameters because of the interactions among temperature, CO2, and precipitation on plant growth and development and also on the biotic stresses of weeds, insects, and diseases. Agronomists will have to consider the variations in temperature and precipitation as part of the production system if they are to ensure the food security required by an ever increasing population