Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

<b>Background</b><p></p> Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.<p></p> <b>Methods/Design</b><p></p> Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.<p></p> We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.<p></p> <b>Discussion</b><p></p> Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms

One loop renormalization of the four-dimensional theory for quantum dilaton gravity.

We study the one loop renormalization in the most general metric-dilaton theory with the second derivative terms only. The general theory can be divided into two classes, models of one are equivalent to conformally coupled with gravity scalar field and also to general relativity with cosmological term. The models of second class have one extra degree of freedom which corresponds to dilaton. We calculate the one loop divergences for the models of second class and find that the arbitrary functions of dilaton in the starting action can be fine-tuned in such a manner that all the higher derivative counterterms disappear on shell. The only structures in both classical action and counterterms, which survive on shell, are the potential (cosmological) ones. They can be removed by renormalization of the dilaton field which acquire the nontrivial anomalous dimension, that leads to the effective running of the cosmological constant. For some of the renormalizable solutions of the theory the observable low energy value of the cosmological constant is small as compared with the Newtonian constant. We also discuss another application of our result.Comment: 21 pages, latex, no figures

CP^{N-1} models and the Quantized 2D Black Holes

We have examined the coupled system of the dilaton gravity and the $CP^{N-1}$ theory known as a model of the confinement of massive scalar quarks. After the quantization of the system, we could see the quantum effect of the gravitation on the coupling constant of $CP^{N-1}$ model and how the coupling constant of dynamically induced gauge field changes near the black hole configuration.Comment: 12 pages, Late

Ekpyrotic collapse with multiple fields

A scale invariant spectrum of isocurvature perturbations is generated during collapse in the scaling solution in models where two or more fields have steep negative exponential potentials. The scale invariance of the spectrum is realised by a tachyonic instability in the isocurvature field. We show that this instability is due to the fact that the scaling solution is a saddle point in the phase space. The late time attractor is identified with a single field dominated ekpyrotic collapse in which a steep blue spectrum for isocurvature perturbations is found. Although quantum fluctuations do not necessarily to disrupt the classical solution, an additional preceding stage is required to establish classical homogeneity.Comment: 13 pages, 1 figur

Survival Improvements in Adolescents and Young Adults after Myeloablative Allogeneic Transplantation for Acute Lymphoblastic Leukemia

AbstractAdolescents and young adults (AYAs, ages 15 to 40 years) with cancer have not experienced survival improvements to the same extent as younger and older patients. We compared changes in survival after myeloablative allogeneic hematopoietic cell transplantation (HCT) for acute lymphoblastic leukemia (ALL) among children (n = 981), AYAs (n = 1218), and older adults (n = 469) who underwent transplantation over 3 time periods: 1990 to 1995, 1996 to 2001, and 2002 to 2007. Five-year survival varied inversely with age group. Survival improved over time in AYAs and paralleled that seen in children; however, overall survival did not change over time for older adults. Survival improvements were primarily related to lower rates of early treatment-related mortality in the most recent era. For all cohorts, relapse rates did not change over time. A subset of 222 AYAs between the ages of 15 and 25 at 46 pediatric or 49 adult centers were also analyzed to describe differences by center type. In this subgroup, there were differences in transplantation practices among pediatric and adult centers, although HCT outcomes did not differ by center type. Survival for AYAs undergoing myeloablative allogeneic HCT for ALL improved at a similar rate as survival for children

The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review

Background: Plantar heel pain is a commonly occurring foot complaint. Stretching is frequently utilised as a treatment, yet a systematic review focusing only on its effectiveness has not been published. This review aimed to assess the effectiveness of stretching on pain and function in people with plantar heel pain. Methods: Medline, EMBASE, CINAHL, AMED, and The Cochrane Library were searched from inception to July 2010. Studies fulfilling the inclusion criteria were independently assessed, and their quality evaluated using the modified PEDro scale. Results: Six studies including 365 symptomatic participants were included. Two compared stretching with a control, one study compared stretching to an alternative intervention, one study compared stretching to both alternative and control interventions, and two compared different stretching techniques and durations. Quality rating on the modified Pedro scale varied from two to eight out of a maximum of ten points. The methodologies and interventions varied significantly between studies, making meta-analysis inappropriate. Most participants improved over the course of the studies, but when stretching was compared to alternative or control interventions, the changes only reached statistical significance in one study that used a combination of calf muscle stretches and plantar fascia stretches in their stretching programme. Another study comparing different stretching techniques, showed a statistically significant reduction in some aspects of pain in favour of plantar fascia stretching over calf stretches in the short term. Conclusions: There were too few studies to assess whether stretching is effective compared to control or other interventions, for either pain or function. However, there is some evidence that plantar fascia stretching may be more effective than Achilles tendon stretching alone in the short-term. Appropriately powered randomised controlled trials, utilizing validated outcome measures, blinded assessors and long-term follow up are needed to assess the efficacy of stretching

Curvature perturbations from ekpyrotic collapse with multiple fields

A scale-invariant spectrum of isocurvature perturbations is generated during collapse in the ekpyrotic scaling solution in models where multiple fields have steep negative exponential potentials. The scale invariance of the spectrum is realized by a tachyonic instability in the isocurvature field. This instability drives the scaling solution to the late time attractor that is the old ekpyrotic collapse dominated by a single field. We show that the transition from the scaling solution to the single field dominated ekpyrotic collapse automatically converts the initial isocurvature perturbations about the scaling solution to comoving curvature perturbations about the late-time attractor. The final amplitude of the comoving curvature perturbation is determined by the Hubble scale at the transition.Comment: 15 pages, 3 figures, a reference added, to be published in CQG, a remark on the comoving density perturbation correcte

Nonminimal Couplings in the Early Universe: Multifield Models of Inflation and the Latest Observations

Models of cosmic inflation suggest that our universe underwent an early phase of accelerated expansion, driven by the dynamics of one or more scalar fields. Inflationary models make specific, quantitative predictions for several observable quantities, including particular patterns of temperature anistropies in the cosmic microwave background radiation. Realistic models of high-energy physics include many scalar fields at high energies. Moreover, we may expect these fields to have nonminimal couplings to the spacetime curvature. Such couplings are quite generic, arising as renormalization counterterms when quantizing scalar fields in curved spacetime. In this chapter I review recent research on a general class of multifield inflationary models with nonminimal couplings. Models in this class exhibit a strong attractor behavior: across a wide range of couplings and initial conditions, the fields evolve along a single-field trajectory for most of inflation. Across large regions of phase space and parameter space, therefore, models in this general class yield robust predictions for observable quantities that fall squarely within the "sweet spot" of recent observations.Comment: 17pp, 2 figs. References added to match the published version. Published in {\it At the Frontier of Spacetime: Scalar-Tensor Theory, Bell's Inequality, Mach's Principle, Exotic Smoothness}, ed. T. Asselmeyer-Maluga (Springer, 2016), pp. 41-57, in honor of Carl Brans's 80th birthda

Higher spin AdS_3 supergravity and its dual CFT

Vasiliev's higher spin supergravity theory on three dimensional anti-de Sitter space is studied and, in particular, the partition function is computed at one loop level. The dual conformal field theory is proposed to be the N=(2,2) CP^N Kazama-Suzuki model in two dimensions. The proposal is based on symmetry considerations and comparison of the bulk partition function with the conformal field theory. Our findings suggest that the theory is strong-weak self-dual.Comment: 36 page

Logarithmic Corrections to Extremal Black Hole Entropy from Quantum Entropy Function

We evaluate the one loop determinant of matter multiplet fields of N=4 supergravity in the near horizon geometry of quarter BPS black holes, and use it to calculate logarithmic corrections to the entropy of these black holes using the quantum entropy function formalism. We show that even though individual fields give non-vanishing logarithmic contribution to the entropy, the net contribution from all the fields in the matter multiplet vanishes. Thus logarithmic corrections to the entropy of quarter BPS black holes, if present, must be independent of the number of matter multiplet fields in the theory. This is consistent with the microscopic results. During our analysis we also determine the complete spectrum of small fluctuations of matter multiplet fields in the near horizon geometry.Comment: LaTeX file, 52 pages; v2: minor corrections, references adde