A Critical Evaluation Of The Trigger Point Phenomenon

The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (fibromyalgia syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the “vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatments predicated on presumed pathology. Therefore the theory of MPS caused by TrPs has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced

Trapping cold atoms using surface-grown carbon nanotubes

We present a feasibility study for loading cold atomic clouds into magnetic traps created by single-wall carbon nanotubes grown directly onto dielectric surfaces. We show that atoms may be captured for experimentally sustainable nanotube currents, generating trapped clouds whose densities and lifetimes are sufficient to enable detection by simple imaging methods. This opens the way for a novel type of conductor to be used in atomchips, enabling atom trapping at sub-micron distances, with implications for both fundamental studies and for technological applications

Survival of small populations under demographic stochasticity

We estimate the mean time to extinction of small populations in an environment with constant carrying capacity but under stochastic demography. In particular, we investigate the interaction of stochastic variation in fecundity and sex ratio under several different schemes of density dependent population growth regimes. The methods used include Markov chain theory, Monte Carlo simulations, and numerical simulations based on Markov chain theory. We find a strongly enhanced extinction risk if stochasticity in sex ratio and fluctuating population size act simultaneously as compared to the case where each mechanism acts alone. The distribution of extinction times deviates slightly from a geometric one, in particular for short extinction times. We also find that whether maximization of intrinsic growth rate decreases the risk of extinction or not depends strongly on the population regulation mechanism. If the population growth regime reduces populations above the carrying capacity to a size below the carrying capacity for large r (overshooting) then the extinction risk increases if the growth rate deviates from an optimal r-value

Cost-effectiveness of a smoking cessation program after myocardial infarction

AbstractObjectives. The purpose of this study was to evaluate the cost-effectiveness of a smoking cessation program initiated after acute myocardial infarction.Background. The value of allocating health care resources to smoking cessation programs after myocardial infarction has not been compared with the value of other currently accepted interventions.Methods. A model was developed to examine the cost-effectiveness of a recently reported smoking cessation program after an acute myocardial infarction. The cost was estimated by considering the resources necessary to implement the program, and the effectiveness was expressed as discounted years of life saved. Years of life saved were estimated by modeling life expectancy using a single declining exponential approximation of life expectancy based on data from published reports.Results. The cost-effectiveness of the nurse-managed smoking cessation program was estimated to be $220/year of life saved. In a one-way sensitivity analysis, the cost-effectiveness of the program remained <$20,000/year of life saved if the program decreased the smoking rate by only 3/1,000 smokers (baseline assumption 26/100 smokers), or if the program cost as much as $8,840/smoker (baseline assumption$100). In a two-way sensitivity analysis, even if the cost of the program were as high as $2,000/participant, the cost-effectiveness of the program would be <$10,000/year of life saved so as the an program helped an additional 12 smokers quit for every 100 enrolled.Conclusions. Over a wide range of estimates of costs and effectiveness, a nurse-managed smoking cessation program after acute myocardial infarction is an extremely cost-effective intervention. This program is more cost-elective than beta-adrenergic antagonist therapy after myocardial infarction

Agreement between definitions of pharmaceutical opioid use disorders and dependence in people taking opioids for chronic non-cancer pain (POINT): a cohort study

Background Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used. We compared how WHO\u27s ICD-10 and proposed ICD-11 and the American Psychiatric Association\u27s DSM-IV and DSM-5 classified individuals in a community-based sample of Australians with chronic non-cancer pain for which opioids have been prescribed. Methods We studied participants in the Pain and Opioid IN Treatment (POINT) cohort, a 2 year prospective cohort study of 1514 people prescribed pharmaceutical opioids for their chronic pain who were recruited in 2012–13 from community-based pharmacies across Australia. After giving patients the Composite International Diagnostic Interview about their opioid use, we assessed which patients would be categorised as having disorders of pharmaceutical opioid use by ICD-10, the draft ICD-11, DSM-IV, and DSM-5. We examined agreement between classification systems, and tested the unidimensionality of the syndrome with confirmatory factor analysis. Findings We included 1422 participants (median time of pain disorder 10 years [IQR 5–20]; median length of strong opioid prescription 4 years [IQR 1·5–10·0]; mean age 58 years). Similar proportions of individuals met lifetime criteria for dependence with DSM-IV (127; 8·9%), ICD-10 (121; 8·5%), and ICD-11 (141; 9·9%). Criteria in DSM-5 classified 127 (8·9%) participants with moderate or severe use disorder. There was excellent agreement between ICD-10, ICD-11 and DSM-IV dependence (κ\u3e0·90). However, there was only fair to moderate agreement between ICD-10 and DSM-IV dependence diagnoses, and DSM-5 use disorder (mild, moderate, or severe). There was only good agreement between moderate to severe use disorder in DSM-5 and the other definitions. Criteria for all definitions loaded well on a single factor; the best model fit was for the definition for dependence in the draft ICD-11, the worst was in DSM-5. Interpretation Classification of problematic pharmaceutical opioid use varies across editions of ICD and DSM. The much lower levels of agreement between DSM-5 and other definitions than between other definitions might be attributed to DSM-5 containing an increased number of criteria and treating dependence and problematic use as a continuum. The more parsimonious ICD-11 dependence definition showed excellent model fit and excellent agreement with previous classificatory systems

A demographic history of a population of howler monkeys (Alouatta palliata) living in a fragmented landscape in Mexico

Long-term field studies are critical for our understanding of animal life history and the processes driving changes in demography. Here, we present long-term demographic data for the northernmost population of mantled howler monkeys (Alouatta palliata) residing in a highly anthropogenically fragmented landscape in Los Tuxtlas, Mexico. We carried out 454 monthly group visits to 10 groups of mantled howler monkeys between 2000 and 2011. The population remained relatively stable over the 11-year study period, with an overall increase in the total number of individuals. Birth rates and inter-birth intervals were comparable to those of howler monkeys at non-fragmented sites, suggesting that living in a fragmented landscape did not affect the reproductive output of our study population. Moreover, despite the landscape, dispersal events were commonplace, including many secondary dispersals (individuals emigrating from groups that they had previously immigrated into). Finally, we found a marked effect of seasonality on the dynamics of our study population. In particular, the period of lowest temperatures and resource scarcity between November and March was associated with higher mortality and reproductive inhibition, while the period of resource abundance between April and May was associated with the majority of conceptions and weaning of offspring. This, in turn, could be influencing dispersal patterns in our study area, as male howler monkeys seem to time some of their immigrations into new groups to coincide with the start of the period of higher fertility, while females preferentially joined new groups several months before the onset of this period. These data have important implications for the conservation and management of howler monkeys in fragmented landscapes, as well as for our understanding of the effect of seasonality over howler monkey dispersal, reproduction and survival

An evolutionary stress-response hypothesis for chronic widespread pain (fibromyalgia syndrome). Pain Med

Abstract Objective. The study aimed to seek a unifying biological basis for the phenomena encompassed in fibromyalgia syndrome (chronic widespread pain and associated morbidities). Setting. While much progress has been made in the last decade in understanding chronic widespread pain, its pathogenesis remains stubbornly obscure and its treatment difficult. Two themes are gaining currency in the field: that chronic widespread pain is the result of central sensitization of nociception, and that chronic pain is somehow related to activation of a global stress response. Design. In this article we merge these two ideas within the perspective of evolutionary biology to generate a hypothesis about the critical molecular pathway involved in chronic stress response activation, namely substance P and its preferred receptor, neurokinin-1 (NK-1R), which has many empirically testable implications. Conclusion. Drawing on diverse findings in neurobiology, immunology, physiology, and comparative biology, we suggest that the form of central sensitization that leads to the profound phenomenological features of chronic widespread pain is part of a whole-organism stress response, which is evolutionarily conserved, following a general pattern found in the simplest living systems

Does 'mentoring’ offer effective support to autistic adults?: a mixed methods pilot study

Two overwhelmingly important drivers for the need for mentoring are mental wellbeing, and unemployment. Regarding the former, a number of studies now show that adults on the autism spectrum have relatively high rates of anxiety, depression, and suicidality . This is likely to be a result of feeling isolated and excluded in society. Regarding the latter, the National Audit Office’s 2009 report Supporting People with Autism through Adulthood highlighted that only 12% of respondents of the NAO survey were in full-time paid employment; and 70% identified mental health problems. These figures are also supported elsewhere, although they are likely to underestimate the numbers of non-identified people on the autism spectrum in employment. The motivation behind the present mentoring study was to evaluate if mentoring might serve as an effective intervention to promote mental wellbeing and greater levels of employment in adults on the autism spectrum. Given resources, the present study could not be designed as a large scale quantitative randomised control trial. Instead, it was set up as a small mixed -methods preliminary pilot study in order for the research funder and research team to learn what the issues were, with a view of gathering information and preliminary evidence that would be needed in the event of a large scale study

Does ‘mentoring’ offer effective support to autistic adults?: a mixed methods pilot study

The Research Autism Cygnet Mentoring project was a two-year pilot study, completed in 2016, which aimed to develop, trial and evaluate a mentoring scheme designed with input from autistic people, their families and supporters. The mentoring scheme involved 12 matched pairs (mentor/mentee) meeting once per week for one hour, over a six month period. All mentors attended a training day, led by the principles of Personal Construct Theory (PCT) and an emancipatory research ethos. The project and training involved significant involvement of autistic people in both its design and delivery. Participants on the autism spectrum found their mentoring experience very helpful in enabling them to progress toward self-identified goals, and mentees felt empowered by the person-centred ethos and methods employed on the project. However, a number of aspects of the mentoring project have been identified for requiring further investigation, including: caution over offering mentoring without formal structures, boundary setting, supervision, flexibility, and the matching of mentees with mentors. The project has highlighted the potential benefits of time-limited goal-orientated mentoring and the negligible evidence base underpinning current mentoring practice with adults on the autism spectrum. In order for the project to realise its emancipatory aim, there is a need for a large-scale quantitative study and a health-economics analysis to provide the necessary evidence base for mentoring to be recommended as a cost-effective intervention with clear benefits for individual wellbeing

Executive Summary: Research Autism Cygnet Mentoring Project

The support requirements of intellectually able adults with autism can be just as nuanced as those for people who have significant learning difficulties/disabilities. Intellectual ability can often mask this, leaving individuals without the backup they require in order to thrive. At the 2007 forum ‘Successful Futures for Adults with Autism’ participants’ highlighted challenges around navigating social life, managing practical and financial affairs, accessing education and training opportunities, securing and maintaining employment, and good physical and mental health. Participants deemed existing models of support, often involving being part of a large group, stressful and inadequate. Many expressed preference for a one-to-one relationship (which could then be broadened over time), based on time-limited goal-oriented, specialist mentoring or life coaching