The Management of Chronic Myofascial Thoracolumbar Pain with Dry Needling, Spinal Manipulation, Cognitive Behavioral Therapy and Exercise: A Case Report

Background & Purpose: Chronic pain suffers have been shown to be comorbid with psychosocial impairments such as anxiety, depression and pain catastrophizing. Cognitive Behavioral Therapy (CBT) is a popular non-pharmacological treatment that has shown efficacious outcomes in reducing pain and disability levels in chronic pain suffers. Myofascial pain syndrome is a pain condition within the soft tissue that is perpetrated by myofascial trigger points (MTrP). MTrPs are associated with greater disability, poorer sleep quality and altered muscle activation patterns. MTrPs are also correlated with the development of central sensitization and chronic pain syndromes. Dry needling (DN) and Spinal Manipulative Therapy (SMT) have shown to reduce pain and disability in MTrP. The purpose of this case report is to provide a treatment rationale and documentation of the efficacy of combining CBT, DN, SMT and exercise in the management of an individual with chronic myofascial pain syndrome. Case Description: A 33-year-old male veteran was referred to therapy with a chief complaint of a constant, dull burning mid-scapular ache extending down to his lower back and up to his trapezius on the right side. He described this pain as 6/10 at current and constant, 5/10 at best with rest and pain medication and 10/10 at worst that occurs intermittently with prolonged sitting, walking and particularly forward-bending. Physical impairments included decreased and painful active range of motion, thoracic spine and rib hypomobility, and lumbar spine hypermobility with a positive prone instability test. MTrPs were identified along the T6-8 paraspinals, rhomboids at the medial border of the right scapula and lumbar segments L1-2 and L4-5. The patient was treated for nine 30-minute treatment sessions following a one-hour initial evaluation. DN was performed in 4/10 sessions; CBT, SMT and exercise were performed in every session. Outcomes: Pain intensity and catastrophizing were measured by the Numeric Pain Rating Scale (NPRS) and Pain Catastrophizing Scale (PCS). Disability was measured by the Oswestry Disability Index (ODI) and the Patient Specific Functional Scale (PSFS). Active functional movement was measured using the Selective Functional Movement Assessment (SFMA). Following ten treatments, NPRS improved from 7/10 to 3/10, PCS improved from 31/52 to 16/52, and ODI improved from 72% to 8%. PSFS to return to golfing improved from a perceived ability of as a 7/10 ability and return to CrossFit activities as 8/10. SFMA multi-segmental flexion and rotation and overhead squat improved to functional painful while single leg stance improved to functional non-painful. Thoracic spine and rib mobility improved to a grade 3 without pain. Discussion: Pain intensity, catastrophizing, disability and functional movement were all improved following nine treatment sessions. The outcomes of this case report suggest a multimodal treatment approach of DN, SMT, CBT and exercise may be beneficial for individuals with chronic myofascial pain

A Multivariate Homogeneously Weighted Moving Average Control Chart

This paper presents a multivariate homogeneously weighted moving average (MHWMA) control chart for monitoring a process mean vector. The MHWMA control chart statistic gives a specific weight to the current observation, and the remaining weight is evenly distributed among the previous observations. We present the design procedure and compare the average run length (ARL) performance of the proposed chart with multivariate Chi-square, multivariate EWMA, and multivariate cumulative sum control charts. The ARL comparison indicates superior performance of the MHWMA chart over its competitors, particularly for the detection of small shifts in the process mean vector. Examples are also provided to show the application of the proposed chart. - 2013 IEEE.Scopu

Processing, Adhesion and Corrosion-inhibiting Properties of Poly[2-methoxy-5-(2’-ethylhexyloxy)-1,4-phenylene vinylene], (MEH-PPV) on Aerospace Aluminum Alloys

Researchers at the Naval Air Warfare Center Weapons Division (NAWCWD) and Wright-Patterson Air Force Base (WPAFB) investigated poly[2-methoxy-5-(2’-ethylhexyloxy)-1,4-phenylene vinylene], (MEH-PPV) for its potential corrosion-inhibition properties on aerospace aluminum alloy AA2024-T3. Solution processing of the polymer, as well as adhesion testing and accelerated weathering tests were performed on MEH-PPV full military aerospace coatings. Wet and dry tape adhesion testing, as well as pencil hardness, impact flexibility and pneumatic adhesion tensile test instrument (PATTI) testing were used to demonstrate the adhesion performance of MEH-PPV on aluminum substrates. The results showed that MEH-PPV had acceptable adhesion characteristics when compared to hexavalent chromium (Cr(VI)) based coatings in all of these tests. Accelerated weathering analysis was performed on MEH-PPV coatings to determine their corrosion protection and weathering resistance capabilities. These tests included neutral salt spray (NSS) exposure and xenon-arc lamp testing. The results showed that while MEH-PPV does not exhibit significant color change after 500 hours of xenon arc lamp exposure, the polymer has poor corrosion protection performance under aggressive salt environments

Changing organizational culture: using the CEO cancer gold standard policy initiatives to promote health and wellness at a school of public health

BACKGROUND: Worksite wellness initiatives for health promotion and health education have demonstrated effectiveness in improving employee health and wellness. We examined the effects of a multifaceted health promotion campaign on organizational capacity to meet requirements to become CEO Cancer Gold Standard Accredited. METHODS: We conducted an online survey to assess perceived organizational values and support for the five CEO Cancer Gold Standard Pillars for cancer prevention: tobacco cessation; physical activity; nutrition; cancer screening and early detection; and accessing information on cancer clinical trials. Baseline and follow-up surveys were sent 6-months apart to faculty, staff, and students at a school of public health to test the impact of a multifaceted health promotion campaign on perceived organizational change. Descriptive analyses were used to characterize percent improvement. Multivariate logistic regression analyses were used to control for participants’ university status. RESULTS: The current organizational culture highly supported tobacco cessation at both time points. Significant improvements (p < .05) from baseline to follow-up were observed for questions measuring organizational values for ‘prevention, screening, and early detection of cancer’ and ‘accessing cancer treatment and clinical trials’. CONCLUSIONS: Health promotion and education efforts using multiple approaches were effective to improve perceived organizational values and support for cancer prevention and early detection, and increase access to information about cancer clinical trials. Future studies are needed to examine broader impacts of implementing worksite health promotion initiatives

Precarious rock methodology for seismic hazard: Physical testing, numerical modeling and coherence studies

This report covers the following projects: Shake table tests of precarious rock methodology, field tests of precarious rocks at Yucca Mountain and comparison of the results with PSHA predictions, study of the coherence of the wave field in the ESF, and a limited survey of precarious rocks south of the proposed repository footprint. A series of shake table experiments have been carried out at the University of Nevada, Reno Large Scale Structures Laboratory. The bulk of the experiments involved scaling acceleration time histories (uniaxial forcing) from 0.1g to the point where the objects on the shake table overturned a specified number of times. The results of these experiments have been compared with numerical overturning predictions. Numerical predictions for toppling of large objects with simple contact conditions (e.g., I-beams with sharp basal edges) agree well with shake-table results. The numerical model slightly underpredicts the overturning of small rectangular blocks. It overpredicts the overturning PGA for asymmetric granite boulders with complex basal contact conditions. In general the results confirm the approximate predictions of previous studies. Field testing of several rocks at Yucca Mountain has approximately confirmed the preliminary results from previous studies, suggesting that the PSHA predictions are too high, possibly because the uncertainty in the mean of the attenuation relations. Study of the coherence of wavefields in the ESF has provided results which will be very important in design of the canisters distribution, in particular a preliminary estimate of the wavelengths at which the wavefields become incoherent. No evidence was found for extreme focusing by lens-like inhomogeneities. A limited survey for precarious rocks confirmed that they extend south of the repository, and one of these has been field tested

Bringing Upstairs Care Downstairs; Integration of Rehabilitation Medicine, Care Management, and the Hospital Elder Life Program (HELP) into an Emergency Department.

Introduction: Services such as physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), social work (SW), care management, and elder life specialists have long been an established part of care for patients admitted to Maine Medical Center (MMC) but not for patients in the Emergency Department (ED). Methods and Results: Driven in part by changes in Medicare reimbursement models, care management established a presence in the Emergency Department (ED) in 2003 with a focus on care planning and cost avoidance. In recent years PT, OT, SLP, SW, and the Hospital Elder Life Program (HELP) have increased their ED involvement substantially. These services not only support care management decisions but have become an invaluable part of the ED team. The timing, staffing models, and roles of these services in our emergency department are described. Discussion: There was strong leadership support to create these positions in the ED. Increased patient volume hospital wide has required staffing flexibility. Initial concerns for slowing the ED where anecdotally resolved. Other hospitals in our system are interested in this approach. Conclusions: While the value of this work feels self-evident and is already established for admitted patients, descriptive and outcome-oriented studies for ED patients would be enlightening

Insight into the Evolution of Anuran Foot Flag Displays: A Comparative Study of Color and Kinematics

Understanding how complex animal displays evolve is a major goal of evolutionary organismal biology. Here, we study this topic by comparing convergently evolved gestural displays in two unrelated species of frog (Bornean Rock Frog, Staurois parvus, and Kottigehara Dancing Frog, Micrixalus kottigeharensis). This behavior, known as a foot flag, is produced when a male ?waves\u27 his hindlimb at another male during bouts of competition for access to mates. We assess patterns of variation in the color of frog feet and the kinematics of the display itself to help pinpoint similarities and differences of the visual signal elements. We find clear species differences in the color of foot webbing, which is broadcast to receivers during specific phases of the display. Analyses of foot-trajectory duration and geometry also reveal clear species differences in display speed and shape - S. parvus generates a faster and more circular visual signal, while M. kottigeharensis generates a much slower and more elliptical one. These data are consistent with the notion that color, speed, and shape likely encode species identity. However, we also found that foot flag speed shows significant among-individual variation, particularly the phase of the display in which foot webbings are visible. This result is consistent with the idea that frogs alter temporal signal components, which may showcase individual condition, quality, or motivation. Overall, our comparative study helps elucidate the variability of foot flagging behavior in a manner that informs how we understand the design principles that underlie its function as a signal in intraspecific communication

Ethnicity and the Writing of Medieval Scottish history

Historians have long tended to define medieval Scottish society in terms of interactions between ethnic groups. This approach was developed over the course of the long nineteenth century, a formative period for the study of medieval Scotland. At that time, many scholars based their analysis upon scientific principles, long since debunked, which held that medieval 'peoples' could only be understood in terms of 'full ethnic packages'. This approach was combined with a positivist historical narrative that defined Germanic Anglo-Saxons and Normans as the harbingers of advances of Civilisation. While the prejudices of that era have largely faded away, the modern discipline still relies all too often on a dualistic ethnic framework. This is particularly evident in a structure of periodisation that draws a clear line between the 'Celtic' eleventh century and the 'Norman' twelfth. Furthermore, dualistic oppositions based on ethnicity continue, particularly in discussions of the law, kingship, lordship and religion

Molecular clouds in M51 from high-resolution extinction mapping

Here we present the cloud population extracted from M51, following the application of our new high-resolution dust extinction technique to the galaxy (Faustino Vieira et al. 2023). With this technique, we are able to image the gas content of the entire disc of M51 down to 5 pc (0.14"), which allows us to perform a statistical characterisation of well-resolved molecular cloud properties across different large-scale dynamical environments and with galactocentric distance. We find that cloud growth is promoted in regions in the galaxy where shear is minimised; i.e. clouds can grow into higher masses (and surface densities) inside the spiral arms and molecular ring. We do not detect any enhancement of high-mass star formation towards regions favourable to cloud growth, indicating that massive and/or dense clouds are not the sole ingredient for high-mass star formation. We find that in the spiral arms there is a significant decline of cloud surface densities with increasing galactocentric radius, whilst in the inter-arm regions they remain relatively constant. We also find that the surface density distribution for spiral arm clouds has two distinct behaviours in the inner and outer galaxy, with average cloud surface densities at larger galactocentric radii becoming similar to inter-arm clouds. We propose that the tidal interaction between M51 and its companion (NGC 5195) - which heavily affects the nature of the spiral structure - might be the main factor behind this.Comment: MNRAS accepted, 20 pages, 16 figure