Randomised controlled trial of exercise for low back pain : clinical outcomes, costs and preferences

Objective: To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities. Design: Randomised controlled trial of progressive exercise programme compared with usual primary care management. Patients' preferences for type of management were elicited independently of randomisation. Participants: 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration. Interventions: Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used. Main outcome measures: Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Roland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services. Results: At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences. Conclusions: The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective

An Independent and External Validation of the ACC NCDR Bleeding Risk Score among a National Multi-Site Community Hospital Registry of Cardiac Interventions

Background: An accurate tool with good discrimination for bleeding would be useful to clinicians for improved management of all their patients. Bleeding risk models have been published but not externally validated in independent clinical dataset. We chose the NCDR PCI score to validate within a large, multi-site community datasets. The aim of the study was to determine the diagnostic utility of this bleeding risk score tool. Methods: This is a large-scale retrospective analysis utilizing American College of Cardiology data from a 37-hospital health system. The central repository of PCI procedures between 6-1-2009 and 6-30-2012 was utilized to validate the NCDR PCI bleeding risk score (BRS) among 4693 patients. The primary endpoint was major bleeding. Discriminant analysis calculating the receiver operating characteristic curve was performed. Results: There were 143 (3.0%) major bleeds. Mean bleeding risk score was 14.7 (range 3 - 42). Incidence of bleeding by risk category: low (0.5%), intermediate (1.7%), and high risk (7.6%). Patients given heparin had 113 (3.7%) major bleeds and those given bivalirudin had 30 (2.1%) major bleeds. Tool accuracy was poor to fair (AUC 0.78 heparin, 0.65 bivalirudin). Overall accuracy was 0.71 (CI: 0.66-0.76). Accuracy did not improve when confined to just the intermediate risk group (AUC 0.58; CI: 0.55-0.67). Conclusion: Bleeding risk tools have low predictive value. Adjustment for anticoagulation use resulted in poor discrimination because bivalirudin differentially biases outcomes toward no bleeding. The current state of bleeding risk tools provides little support for diagnostic utility in regards to major bleeding and therefore have limited clinical applicability

Factors influencing engagement in postnatal weight management and subsequent weight and well-being outcomes

Many women exceed gestational weight gain recommendations. Successful postnatal weight management decreases the risk of entering further pregnancies obese. This service evaluation investigates women’s motivations to lose weight postnatally, the weight loss achieved and impact on self-esteem. Methods: online survey using quantitative questions to determine motivation and lifestyle behaviours related to post-natal weight management in women attending a commercial weight management organisation. Weekly weights confirmed from digitally recorded data. Results: 1015 responded. Mean joining BMI was 33.3kg/m2 ± 5.85 and when surveyed 30.5kg/m2 ± 5.86, a change of -2.8 ± 0.1 kg/m² (p <0.01, 95% CI 2.76 – 3.11). 463 (45.7%) joined the groups between 6-26 weeks postnatal. Main motivators to lose weight were ‘to improve how I feel about my body size and shape’ (85.2%) and ‘improve self-confidence’ (76.6%) although only ‘to improve my health’ (65.6%) correlated with actual weight loss (0.114, p<0.01). Healthcare professional recommendation was less of a reason (6.5%). Improvements in self-confidence (77.6%), self-esteem (78.6%), wellbeing (85.2%) and body size/shape (70.1%) were reported. Conclusion: Women chose to engage to improve self-confidence, feelings about their body shape and health. There is an opportunity for healthcare professionals to encourage women early after giving birth to engage in weight loss and this may improve outcomes

Molecular Mechanisms Mediating Retinal Reactive Gliosis Following Bone Marrow Mesenchymal Stem Cell Transplantation.

A variety of diseases lead to degeneration of retinal ganglion cells (RGCs) and their axons within the optic nerve resulting in loss of visual function. Although current therapies may delay RGC loss, they do not restore visual function or completely halt disease progression. Regenerative medicine has recently focused on stem cell therapy for both neuroprotective and regenerative purposes. However, significant problems remain to be addressed, such as the long-term impact of reactive gliosis occurring in the host retina in response to transplanted stem cells. The aim of this work was to investigate retinal glial responses to intravitreally transplanted bone marrow mesenchymal stem cells (BM-MSCs) to help identify factors able to modulate graft-induced reactive gliosis. We found in vivo that intravitreal BM-MSC transplantation is associated with gliosis-mediated retinal folding, upregulation of intermediate filaments, and recruitment of macrophages. These responses were accompanied by significant JAK/STAT3 and MAPK (ERK1/2 and JNK) cascade activation in retinal Muller glia. Lipocalin-2 (Lcn-2) was identified as a potential new indicator of graft-induced reactive gliosis. Pharmacological inhibition of STAT3 in BM-MSC cocultured retinal explants successfully reduced glial fibrillary acidic protein expression in retinal Muller glia and increased BM-MSC retinal engraftment. Inhibition of stem cell-induced reactive gliosis is critical for successful transplantation-based strategies for neuroprotection, replacement, and regeneration of the optic nerve.This work was support by funding from the Biotechnology and Biological Sciences Research Council (BBSRC), the HB Allen Charitable Trust, the Cambridge Eye Trust, the Jukes Glaucoma Research Fund and by Pfizer, Neusentis. We thank Dr. Andras Lakatos from the University of Cambridge (UK) for donating the GFAP-STAT3 CKO mice, Prof. Verdon Taylor from the University of Basel (CH) for the Hes5 GFP+ve mice, Dr. Stefano Pluchino from the University of Cambridge (UK) for donating the mouse neural precursor cell (NPC) line and Prof. Astrid Limb from UCL, London (UK) for the MIO-M1 cell line.This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/stem.209

Identification of a critical sulfation in chondroitin that inhibits axonal regeneration.

The failure of mammalian CNS neurons to regenerate their axons derives from a combination of intrinsic deficits and extrinsic factors. Following injury, chondroitin sulfate proteoglycans (CSPGs) within the glial scar inhibit axonal regeneration, an action mediated by the sulfated glycosaminoglycan (GAG) chains of CSPGs, especially those with 4-sulfated (4S) sugars. Arylsulfatase B (ARSB) selectively cleaves 4S groups from the non-reducing ends of GAG chains without disrupting other, growth-permissive motifs. We demonstrate that ARSB is effective in reducing the inhibitory actions of CSPGs both in in vitro models of the glial scar and after optic nerve crush (ONC) in adult mice. ARSB is clinically approved for replacement therapy in patients with mucopolysaccharidosis VI and therefore represents an attractive candidate for translation to the human CNS

Evaluation of Social Impact of Traffic Noice in Amman, Jordan

Few road traffic studies were conducted in Jordan, but the issue is drawing an increasing attention due to its growing magnitude and various impacts as a result of the high increase in vehicular traffic. This study further investigates the issue with the aim of providing an understanding of its social impact on residents of Amman, the capital of Jordan. Traffic noise levels were measured at selected locations along urban arterials and a social survey was performed to examine the reactions and attitudes of the neighboring residents towards these levels of traffic noise. The survey included social characteristics of individuals, and their attitudes towards traffic noise, and how it impacted their daily activities. A predesigned questionnaire was used for this purpose which included questions to evaluate the awareness of respondents of the problem and its environmental and health impacts. The financial impact that residents perceive of noise and the need for attenuation measures were also addressed. The results of the study also revealed that the impact of traffic noise on people can cause annoyance while performing daily activities were 24% of respondents reported that they get annoyed by traffic while working, 49% while resting, 34% while talking to others, 31% while talking on the phone, 39% while reading, 38% while watching TV and 53% of respondents get annoyed while sleeping. The respondents have also pointed out the following effects of noise: twist in mood (53%), headache (36%), and difficulty in concentration (40%). About 57% of respondents think traffic noise reduces the value of their properties and a total of 31% are willing to sell their house at reduced cost. About 59% of respondents consider attenuation measures necessary, and in order to reduce the noise, about 54% of respondents were willing to pay for attenuation measures which reflects the public awareness of the issue magnitude

Oregon State University Libraries and Press Strategic Agenda for Research Data Services

The Strategic Agenda for Research Data Services will guide the development of data services at OSU Libraries from January 2013 to June 2014. The Strategic Agenda is informed by best practices in data management at peer universities. Major elements of the Strategic Agenda include an instructional program on data management, robust data management consultation and planning services, facilitation of OSU participation in open data initiatives, and the development of additional data preservation and sharing infrastructures

Glucocorticoid-induced hyperglycaemia and diabetes : call for action

Diabetes and hyperglycaemia are associated with increased morbidity and large healthcare and economic costs.1 Glucocorticoid-induced diabetes and hyperglycaemia are common. Glucocorticoids are used widely to treat people with inflammatory and autoimmune conditions,2 malignancies3 and in hospitalised patients with COVID-19.4 In the United Kingdom (UK), among hospitalised patients, the prevalence of glucocorticoid use is 10% in all patients5 and 25–40% in those with diabetes.6 This is associated with adverse metabolic outcomes including impaired glycaemic control7 and can manifest as a new-onset diabetes (glucocorticoid-induced diabetes) or worsening hyperglycaemia in people with diabetes (glucocorticoid-induced hyperglycaemia). The hypothesised mechanism for glucocorticoid-induced diabetes and hyperglycaemia is reduced insulin sensitivity and increased gluconeogenesis. Approximately 2% of all newly diagnosed diabetes cases in the United Kingdom are related to glucocorticoid use over a mean duration of 8.9 (±1.7) years.8 A meta-analysis by Liu et al.9 demonstrated that the incidence of glucocorticoid-induced diabetes and hyperglycaemia is 18.6% and 32.3%, respectively, over the period of 1–12 months. Patients from the included studies were adults in outpatient and inpatient settings treated with systemic glucocorticoids for a variety of indications including haematological malignancies, rheumatoid arthritis, pemphigus, pemphigoid, systemic lupus erythematosus, respiratory and neurological conditions.

Service evaluation of weight outcomes as a function of initial BMI in 34,271 adults referred to a primary care/commercial weight management partnership scheme

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