Acupuncture & moxibustion for osteoarthritis of the knee: a component analysis approach

This project investigates the use of acupuncture and moxibustion for osteoarthritis of the knee. The project includes a pilot study which tests a protocol for a randomised controlled trial. Two pieces of primary research that develop new knowledge regarding acupuncture in practice: expert interviews and practitioner survey. A systematic review of clinical trials investigating warm needle acupuncture for osteoarthritis of the knee. A narrative review of the theoretical approaches to treating knee pain with acupuncture. The first phase of the project reviews the literature on the methodological challenges of research into acupuncture. A new framework for acupuncture research is developed. Key issues identified are: a placebo acupuncture technique is inherently impossible; there is no ‘theory of traditional East Asian medicine’ that can be falsified. Component analysis is proposed as a potential solution to these challenges. Moreover, clinical research can only be well designed and properly interpreted if triangulated with knowledge of theory and practice. The knowledge of acupuncture in practice, developed in this project, is used to re-evaluate the evidence-base. The external validity of acupuncture protocols and the risk of bias from the sham procedures are both shown to be problematic. This suggests that previous interpretations underestimate the efficacy of acupuncture. The research also indicates that acupuncture styles, e.g. TCM, cannot be clearly delineated, which has implications for evaluating and reporting clinical trials. In phase 3 of the project, the relationship between physical and psychological components is found to be highly complex. Subsequently, the research framework is further refined to account for this complexity. The pilot study identified problems with the protocol and solutions are proposed The phases of the project are guided by the framework. Therefore, the project not only develops new knowledge regarding osteoarthritis of the knee, but also serves as a demonstration of the component analysis approach which could be utilised to investigate other conditions

Warm Needle Acupuncture vs. Needle Acupuncture for Osteoarthritis of the Knee: A Pilot Study Protocol

Acupuncture has been shown to have clinically relevant benefits for chronic pain. However, interpretation of the results and whether they are due to the placebo effect remains contested. As a complex physical intervention acupuncture presents particular problems in clinical research that seeks to identify a specific effect. The existing evidence mosaic can be enhanced by randomised controlled trials that investigate the specific efficacy of different components of acupuncture. This study investigates the specific efficacy of the conducted heat in warm needle acupuncture. Methods: The study is a randomised, controlled, parallel-group 2-armed clinicaltrial. Itis designed so that the outcome administrator, participants and primary acupuncturist will be blinded to group allocation. Analysis: The primary outcome measures WOMACJ NRS 3.1 score and SF 36 are both considered interval variables and provided the distribution of changes is normally distributed the change in score will be analysed using t-test. The information obtained from interviews with participants will be thematically analysed. Discussion: Compromises from acupuncture in practice have been made in order to devise procedures that can investigate the specific efficacy of the conducted heat of warm needle acupuncture. The way in which these compromises may impact on interpretation of the results is discusse

Utilizing genotyping-by-sequencing to elucidate Neotropical army ant evolution

The articulation of science and humanism has been from the outset one of the keystones of our programmatic initiative on person centered medicine. This involves the notion that the scientific method is what gives science its foundations and at the same time represents one of the principal strategies and tools to understand, formulate and intervene in crucial and paramount human concerns and activities such as health. A scientific approach to health and health care, from the perspective of person centered medicine, involves not only attending to organs and diseases (preferential topics in much of contemporary medicine), but more broadly to the whole field of human health, including ill health and positive health, within which organs and diseases are inscribed. (aut.ref.

Attitudes to and experiences with body weight control and changes in body weight in relation to all-cause mortality in the general population

Background and aimsIncreased body mass index (BMI = weight/height2; kg/m2) and weight gain is associated with increased mortality, wherefore weight loss and avoided weight gain should be followed by lower mortality. This is achieved in clinical settings, but in the general population weight loss appears associated with increased mortality, possibly related to the struggles with body weight control (BWC). We investigated whether attitudes to and experiences with BWC in combination with recent changes in body weight influenced long-term mortality among normal weight and overweight individuals.Population and methodsThe study population included 6,740 individuals attending the 3rd cycle in 1991-94 of the Copenhagen City Heart Study, providing information on BMI, educational level, health behaviours, well-being, weight half-a-year earlier, and answers to four BWC questions about caring for body weight, assumed benefit of weight loss, current and past slimming experiences. Participants reporting previous unintended weight loss (> 4 kg during one year) were excluded. Cox regression models estimated the associations of prior changes in BMI and responses to the BWC questions with approximately 22 years all-cause mortality with age as 'time scale'. Participants with normal weight (BMI ResultsCompared with stable weight, weight loss was associated with significantly increased mortality in the normal weight group, but not in the overweight group, and weight gain was not significantly associated with mortality in either group. Participants with normal weight who claimed that it would be good for their health to lose weight or that they were currently trying to lose weight had significantly higher mortality than those denying it. There were no other significant associations with the responses to the BWC questions in either the normal weight or the overweight group. When combining the responses to the BWC questions with the weight changes, using the weight change as either a continuous or categorical variable, there were no significant interaction in their relation to mortality in either the normal weight or the overweight group.ConclusionAttitudes to and experiences with BWC did not notably modify the association of changes in body weight with mortality in either people with normal weight or people with overweight

Magneto-shear modes and a.c. dissipation in a two-dimensional Wigner crystal

The a.c. response of an unpinned and finite 2D Wigner crystal to electric fields at an angular frequency $\omega$ has been calculated in the dissipative limit, $\omega \tau \ll 1$, where $\tau ^{-1}$ is the scattering rate. For electrons screened by parallel electrodes, in zero magnetic field the long-wavelength excitations are a diffusive longitudinal transmission line mode and a diffusive shear mode. A magnetic field couples these modes together to form two new magneto-shear modes. The dimensionless coupling parameter $\beta =2(c_{t}/c_{l})|\sigma_{xy}/\sigma_{xx}|$ where $c_{t}$ and $c_{l}$ are the speeds of transverse and longitudinal sound in the collisionless limit and $\sigma_{xy}$ and $\sigma_{xx}$ are the tensor components of the magnetoconductivity. For $\beta \geqslant 1$, both the coupled modes contribute to the response of 2D electrons in a Corbino disk measurement of magnetoconductivity. For $\beta \gg 1$, the electron crystal rotates rigidly in a magnetic field. In general, both the amplitude and phase of the measured a.c. currents are changed by the shear modulus. In principle, both the magnetoconductivity and the shear modulus can be measured simultaneously.Comment: REVTeX, 7 pp., 4 eps figure

Warm needle acupuncture for osteoarthritis: A systematic review protocol

Warm needle acupuncture (WA) is widely used the treatment in the East Asian countries. However, there is no critically appraised evidence of the potential benefits and harms. The purpose of this systematic review is to evaluate the efficacy of WA for osteoarthritis (OA). Methods and analysis Electronic databases will be searched: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and AMED, 6 Korean medical databases (Korea Med, the Korean Traditional Knowledge Portal, OASIS, DBPIA, the Research Information Service System and the Korean Studies Information Service System), 3 Chinese databases (CNKI, VIP and Wanfang) and a Japanese database (CiNii Articles) will be searched from their inception. We will be searched from their inception. Selection of the studies and data extraction and validation will be performed independently by two reviewers. Randomised controlled trials (RCTs) and quasi-RCTs using WA for any type of OA will be considered. The studies will independently undertake study selection, extraction of data and assessment of study quality by two authors. Risk of bias will be assessed using the Cochrane risk of bias standards. All data synthesis and subgroup analyses will be conducted using Review Manager Software. Dissemination Findings will be published in a peer-reviewed journals. This systematic review may inform the treatment of OA patients in clinical practic

Sequence Variability of P2-Like Prophage Genomes Carrying the Cytolethal Distending Toxin V Operon in Escherichia coli O157

Cytolethal distending toxins (CDT) are potent cytotoxins of several Gram-negative pathogenic bacteria, including Escherichia coli, in which five types (CDT-I to CDT-V) have been identified so far. CDT-V is frequently associated with Shiga-toxigenic E. coli (STEC), enterohemorrhagic E. coli (EHEC) O157 strains, and strains not fitting any established pathotypes. In this study, we were the first to sequence and annotate a 31.2-kb-long, noninducible P2-like prophage carrying the cdt-V operon from an stx- and eae-negative E. coli O157:H43 strain of bovine origin. The cdt-V operon is integrated in the place of the tin and old phage immunity genes (termed the TO region) of the prophage, and the prophage itself is integrated into the bacterial chromosome between the housekeeping genes cpxP and fieF. The presence of P2-like genes (n = 20) was investigated in a further five CDT-V-positive bovine E. coli O157 strains of various serotypes, three EHEC O157:NM strains, four strains expressing other variants of CDT, and eight CDT-negative strains. All but one CDT-V-positive atypical O157 strain uniformly carried all the investigated genomic regions of P2-like phages, while the EHEC O157 strains missed three regions and the CDT-V-negative strains carried only a few P2-like sequences. Our results suggest that P2-like phages play a role in the dissemination of cdt-V between E. coli O157 strains and that after integration into the bacterial chromosome, they adapted to the respective hosts and became temperate

Comprehensive geriatric assessment in men aged 70 years or older with localised prostate cancer undergoing radical radiotherapy

Aims Treatment decisions for men aged 70 years or over with localised prostate cancer need to take into account the risk of death from competing causes and fitness for the proposed treatment. Objective assessments such as those included in a comprehensive geriatric assessment (CGA) might help to inform the decision-making process. The aim of this study was to describe the CGA scores of a cohort of older men with prostate cancer, evaluate potential screening tools in this population and assess whether any CGA component predicts significant acute radiotherapy toxicity. Materials and methods This was a prospective cohort study undertaking pretreatment CGA, Vulnerable Elders Survey (VES-13) and G8 assessment in patients aged 70 years and over with localised prostate cancer planned to undergo radical external beam radiotherapy. Results In total, 178 participants were recruited over a 3 year period and underwent a CGA. Fifty-five (30.1%) participants were defined as having health needs identified by their CGA. Both VES-13 and G8 screening tools showed a statistically significant association with CGA needs (P < 0.001 and X2 = 15.02, P < 0.001, respectively), but their sensitivity was disappointing. There was no association between a CGA (or its components) and significant acute radiotherapy toxicity. Conclusions Many older men with localised prostate cancer are vulnerable according to a CGA. The screening tools evaluated were not sufficiently sensitive to identify this group. CGA outcome does not predict for significant acute radiotherapy toxicity

Papua New Guinea: a potential refuge for threatened Indo–Pacific river sharks and sawfishes

The conservation of threatened elasmobranchs in tropical regions is challenging due to high local reliance on aquatic and marine resources. Due primarily to fishing pressure, river sharks (Glyphis) and sawfishes (Pristidae) have experienced large population declines in the Indo-Pacific. Papua New Guinea (PNG) may offer a refuge for these species, as human population density is low, and river shark and sawfish populations are thought to persist. However, few data are available on these species in PNG, and risk posed by small-scale fishers is poorly understood. This study observed elasmobranch catches in small-scale fisheries in riverine and coastal environments in the East Sepik (northern region), Gulf, and Western Provinces (southern region) of PNG. Surveys were conducted over a period of weeks to months in each region, during the dry season across seven field trips from 2017 to 2020. We observed a total of 783 elasmobranchs encompassing 38 species from 10 families. River sharks made up 29.4% of observations in the southern region, while sawfishes made up 14.8 and 20.3% in the northern and southern regions, respectively. River sharks were commonly caught by small-scale fishers in lower riverine environments in southern PNG, while sawfishes were generally less common and mainly observed through dried rostra. The primary threat to river shark and sawfish populations is their capture by small-scale fishers targeting teleosts for swim bladder. Persisting populations of river sharks and sawfishes indicate that PNG is the second known nation with viable populations of multiple species in the Indo-Pacific. However, populations are declining or at high risk of decline, and fisheries management and conservation are required to realize the potential of PNG as a long-term refuge

Interaction Effects in a One-Dimensional Constriction

We have investigated the transport properties of one-dimensional (1D) constrictions defined by split-gates in high quality GaAs/AlGaAs heterostructures. In addition to the usual quantized conductance plateaus, the equilibrium conductance shows a structure close to $0.7(2e^2/h)$, and in consolidating our previous work [K.~J. Thomas et al., Phys. Rev. Lett. 77, 135 (1996)] this 0.7 structure has been investigated in a wide range of samples as a function of temperature, carrier density, in-plane magnetic field $B_{\parallel}$ and source-drain voltage $V_{sd}$. We show that the 0.7 structure is not due to transmission or resonance effects, nor does it arise from the asymmetry of the heterojunction in the growth direction. All the 1D subbands show Zeeman splitting at high $B_{\parallel}$, and in the wide channel limit the $g$-factor is $\mid g \mid \approx 0.4$, close to that of bulk GaAs. As the channel is progressively narrowed we measure an exchange-enhanced $g$-factor. The measurements establish that the 0.7 structure is related to spin, and that electron-electron interactions become important for the last few conducting 1D subbands.Comment: 8 pages, 7 figures (accepted in Phys. Rev. B