Physiotherapists’ perceptions of problematic musculoskeletal soft tissue disorders

Original article can be found at: http://www.ijtr.co.uk/ Copyright MA Healthcare Limited.Aims: Many common musculoskeletal disorders are resistant to existing management strategies,causing long-term pain and disability. While arthritic and spinal problems have been prioritized for research, several soft tissue disorders may be equally burdensome for individuals and difficult to treat successfully. dentifying those that are least responsive to reatment may help focus the limited resources available for research and treatment provision. This study aimed to rank the most problematic disorders, and identify contributory factors, to inform the debate on research and service priorities in the management of musculoskeletal disorders. Methods: The views of practising physiotherapists on the most problematic soft tissue disorders were sought using a postal questionnaire survey and telephone interviews. The questionnaire was sent to 193 experienced musculoskeletal physiotherapists working in National Health Service and private clinics in south-east England. Findings: The response rate was 48%. The top three problematic disorders were identifi ed as frozen shoulder, plantar fasciitis and tennis elbow. Subsequent interviews with 20 respondents indicated that inadequate differential diagnosis, triaging and differences in therapeutic practice may account for some of the observed variation in outcomes. Conclusions: A greater focus on these particular disorders and issues by both clinicians and the research community is warranted.Peer reviewe

A hydrological analysis of East Australian floods using Nimbus 5 electrically scanning microwave radiometer data

A chronology of a major Australian flood in 1974 is presented using Nimbus 5 Passive Microwave Data (ESMR) and other conventional and satellite supporting data

On-lattice agent-based simulation of populations of cells within the open-source chaste framework

Over the years, agent-based models have been developed that combine cell division and reinforced random walks of cells on a regular lattice, reaction-diffusion equations for nutrients and growth factors and ordinary differential equations (ODEs) for the subcellular networks regulating the cell cycle. When linked to a vascular layer, this multiple scale model framework has been applied to tumour growth and therapy. Here we report on the creation of an agent-based multiscale environment amalgamating the characteristics of these models within a Virtual Pysiological Human (VPH) Exemplar Project. This project enables re-use, integration, expansion and sharing of the model and relevant data. The agent-based and reactiondiffusion parts of the multiscale model have been implemented and are available for download as part of the latest public release of Chaste (“Cancer, Heart and Soft Tissue Environment”), (http://www.cs.ox.ac.uk/chaste/) version 3.1, part of the VPH Toolkit (http://toolkit.vph-noe.eu/). The environment functionalities are verified against the original models, in addition to extra validation of all aspects of the code. In this work, we present the details of the implementation of the agent-based environment, including the system description, the conceptual model, the development of the simulation model and the processes of verification and validation of the simulation results. We explore the potential use of the environment by presenting exemplar applications of the “what if” scenarios that can easily be studied in the environment. These examples relate to tumour growth, cellular competition for resources and tumour responses to hypoxia. We conclude our work by summarising the future steps for the expansion of the current system

Summary care record early adopter programme: an independent evaluation by University College London.

Benefits The main potential benefit of the SCR is considered to be in emergency and unscheduled care settings, especially for people who are unconscious, confused, unsure of their medical details, or unable to communicate effectively in English. Other benefits may include improved efficiency of care and avoidance of hospital admission, but it is too early for potential benefits to be verified or quantified. Progress As of end April 2008, the SCR of 153,188 patients in the first two Early Adopter sites (Bolton and Bury) had been created. A total of 614,052 patients in four Early Adopter sites had been sent a letter informing them of the programme and their choices for opting out of having a SCR. Staff attitudes and usage The evaluation found that many NHS staff in Early Adopter sites (which had been selected partly for their keenness to innovate in ICT) were enthusiastic about the SCR and keen to see it up and running, but a significant minority of GPs had chosen not to participate in the programme and others had deferred participation until data quality improvement work was completed. Whilst 80 per cent of patients interviewed were either positive about the idea of having a SCR or ?did not mind?, others were strongly opposed ?on principle?. Staff who had attempted to use the SCR when caring for patients felt that the current version was technically immature (describing it as ?clunky? and ?complicated?), and were looking forward to a more definitive version of the technology. A comparable technology (the Emergency Care Summary) introduced in Scotland two years ago is now working well, and over a million records have been accessed in emergency and out-of-hours care. Patient attitudes and awareness Having a SCR is optional (people may opt out if they wish, though fewer than one per cent of people in Early Adopter sites have done so) and technical security is said to be high via a system of password protection and strict access controls. Nevertheless, the evaluation showed that recent stories about data loss by government and NHS organisations had raised concerns amongst both staff and patients that human fallibility could potentially jeopardise the operational security of the system. Despite an extensive information programme to inform the public in Early Adopter sites about the SCR, many patients interviewed by the UCL team were not aware of the programme at all. This raises important questions about the ethics of an ?implied consent? model for creating the SCR. The evaluation recommended that the developers of the SCR should consider a model in which the patient is asked for ?consent to view? whenever a member of staff wishes to access their record. Not a single patient interviewed in the evaluation was confident that the SCR would be 100 per cent secure, but they were philosophical about the risks of security breaches. Typically, people said that the potential benefit of a doctor having access to key medical details in an emergency outweighed the small but real risk of data loss due to human or technical error. Even patients whose medical record contained potentially sensitive data such as mental health problems, HIV or drug use were often (though not always) keen to have a SCR and generally trusted NHS staff to treat sensitive data appropriately. However, they and many other NHS patients wanted to be able to control which staff members were allowed to access their record at the point of care. Some doctors, nurses and receptionists, it seems, are trusted to view a person?s SCR, whereas others are not, and this is a decision which patients would like to make in real time

Seasonal persistence of circulation anomalies in the Southern Hemisphere stratosphere, and its implications for the troposphere

Previous studies have highlighted an important organising influence of the seasonal Southern Hemisphere stratospheric vortex breakdown on the large-scale stratospheric and tropospheric circulation. The present study extends this work by considering the statistical predictability of the stratospheric vortex breakdown event, using re-analysis data. Perturbations to the winter stratospheric vortex are shown to persist into austral spring, and to lead to a shift in the statistics of the breakdown event during austral summer. This is interpreted as evidence for the potential for seasonal predictability of the vortex breakdown event in the stratosphere. Coupled variability between the stratosphere and troposphere is then considered. The semi-annual oscillation of the tropospheric mid-latitude jet is discussed and evidence for a connection between this behaviour and variations in the stratosphere is presented. Based on this connection, an argument is made for the concomitant potential for seasonal predictability in the troposphere, assuming knowledge of the stratospheric initial state. Combining these various results, a non-stationary, regime-based perspective of large-scale extra-tropical Southern Hemisphere circulation variability between late winter and summer is proposed. The implications of this perspective for some previous studies involving Annular Modes of the circulation are discussed. In particular, the long Annular Mode timescales during austral spring and summer should not be interpreted as an increased persistence of perturbations to some slowly varying seasonal cycle, but instead reflect a phase shift of the seasonal cycle induced by stratospheric variability

Sheep grazing experiment with mown and unmown pasture, Chapman Research Station, 1958-1959

INVESTIGATIONS carried out several years ago at the Avondale, Chapman and * Wongan Hills Research Station showed that increased wool yields and reduced liveweight losses could be obtained by grazing sheep on pasture which had been mown at the hay stage and left in the paddock instead of allowing it to mature and dry off normally

Subseasonal-to-seasonal predictability of the Southern Hemisphere eddy-driven jet during austral spring and early summer

Several recent studies have suggested that the stratosphere can be a source of subseasonal-to-seasonal predictability of Southern Hemisphere circulation during the austral spring and early summer seasons, through its influence on the eddy-driven jet. We exploit the large sample size afforded by the hindcasts from the European Centre for Medium-Range Weather Forecasts Integrated Forecast System to address a number of unanswered questions. It is shown that the picture of coherent seasonal variability of the coupled stratosphere-troposphere system apparent from the reanalysis record during the spring/early summer period is robust to sampling uncertainty, and that there is evidence of nonlinearity in the case of the most extreme variations. The effect of El Nino-Southern Oscillation on the eddy-driven jet during this time of year is found to occur via the stratosphere, with no evidence of a direct tropospheric pathway. A simple two-state statistical model of the stratospheric vortex is introduced to estimate the subseasonal-to-seasonal predictability associated with shifts of the seasonal cycle in the SH extratropical atmosphere. This simple model, along with a more general model, are subsequently used to interpret skill scores associated with hindcasts made using the full seasonal forecast model. Together the results provide evidence of tropospheric predictability on subseasonal-to-seasonal timescales from at least as early as August 1, and show no evidence of a `signal-to-noise paradox' between the full seasonal forecast model and the reanalysis

Noise Impacts from Professional Dog Grooming Forced-Air Dryers

This study was designed to measure the sound output of four commonly used brands of forced-air dryers used by dog groomers in the United States. Many dog groomers have questions about the effect of this exposure on their hearing, as well as on the hearing of the dogs that are being groomed. Readings taken from each dryer at 1 meter (the likely distance of the dryer from the groomer and the dog) showed average levels ranging from 105.5 to 108.3 dB SPL or 94.8 to 108.0 dBA. Using the 90 dBA criterion required by the US Occupational Safety and Health Administration, dog groomers/bathers are at risk if exposure to the lowest intensity dryer (94.8 dBA) exceeds 4 hours per day. If the more stringent 85 dBA criterion and 3 dB tradeoff is applied, less than one hour of exposure is permissible in an 8 hour day. Cautions are recommended for any persons exposed to noise from forced-air dryers

Cytosolic recognition of flagellin by mouse macrophages restricts Legionella pneumophila infection.

To restrict infection by Legionella pneumophila, mouse macrophages require Naip5, a member of the nucleotide-binding oligomerization domain leucine-rich repeat family of pattern recognition receptors, which detect cytoplasmic microbial products. We report that mouse macrophages restricted L. pneumophila replication and initiated a proinflammatory program of cell death when flagellin contaminated their cytosol. Nuclear condensation, membrane permeability, and interleukin-1beta secretion were triggered by type IV secretion-competent bacteria that encode flagellin. The macrophage response to L. pneumophila was independent of Toll-like receptor signaling but correlated with Naip5 function and required caspase 1 activity. The L. pneumophila type IV secretion system provided only pore-forming activity because listeriolysin O of Listeria monocytogenes could substitute for its contribution. Flagellin monomers appeared to trigger the macrophage response from perforated phagosomes: once heated to disassemble filaments, flagellin triggered cell death but native flagellar preparations did not. Flagellin made L. pneumophila vulnerable to innate immune mechanisms because Naip5+ macrophages restricted the growth of virulent microbes, but flagellin mutants replicated freely. Likewise, after intratracheal inoculation of Naip5+ mice, the yield of L. pneumophila in the lungs declined, whereas the burden of flagellin mutants increased. Accordingly, macrophages respond to cytosolic flagellin by a mechanism that requires Naip5 and caspase 1 to restrict bacterial replication and release proinflammatory cytokines that control L. pneumophila infection

Purification and Characterization of meta-Cresol Purple for Spectrophotometric Seawater pH Measurements

Spectrophotometric procedures allow rapid and precise measurements of the pH of natural waters. However, impurities in the acid–base indicators used in these analyses can significantly affect measurement accuracy. This work describes HPLC procedures for purifying one such indicator, meta-cresol purple (mCP), and reports mCP physical–chemical characteristics (thermodynamic equilibrium constants and visible-light absorbances) over a range of temperature (T) and salinity (S). Using pure mCP, seawater pH on the total hydrogen ion concentration scale (pHT) can be expressed in terms of measured mCP absorbance ratios (R = λ2A/λ1A) as follows:where −log(K2Te2) = a + (b/T) + c ln T – dT; a = −246.64209 + 0.315971S + 2.8855 × 10–4S2; b = 7229.23864 – 7.098137S – 0.057034S2; c = 44.493382 – 0.052711S; d = 0.0781344; and mCP molar absorbance ratios (ei) are expressed as e1 = −0.007762 + 4.5174 × 10–5T and e3/e2 = −0.020813 + 2.60262 × 10–4T + 1.0436 × 10–4 (S – 35). The mCP absorbances, λ1A and λ2A, used to calculate R are measured at wavelengths (λ) of 434 and 578 nm. This characterization is appropriate for 278.15 ≤ T ≤ 308.15 and 20 ≤ S ≤ 40