Use of a goal setting intervention to increase adherence to low back pain rehabilitation: A randomized controlled trial

Objective: To examine the effects of a goal setting intervention on self efficacy, treatment efficacy, adherence and treatment outcome in patients undergoing low back pain rehabilitation. Design: A mixed-model 2 (Time) x 3 (Group) randomized controlled trial. Setting: A residential rehabilitation centre for military personnel. Subjects: UK military personnel volunteers (N=48); mean age was 32.9 (SD 7.9) with a diagnosis of non-specific low back pain. Interventions: Subjects were randomly assigned to either a goal setting experimental group (Exp, n=16), therapist-led exercise therapy group (C1, n=16), or non-therapist-led exercise therapy group (C2, n=16). Treatment duration for all groups was 3 weeks. Main measures: Self-efficacy, treatment efficacy and treatment outcome were recorded before and after the treatment period. Adherence was rated during regularly scheduled treatment sessions using the Sports Injury Rehabilitation Adherence Scale (SIRAS). The Biering-Sørensen test was used as the primary measure of treatment outcome. Results: ANCOVA results showed that adherence scores were significantly higher in the experimental group (13.70 ± 1.58) compared with C2 (11.74 ± 1.35), (P<0.025). There was no significant difference for adherence between the experimental group and C1 (P=0.13). Self-efficacy was significantly higher in the experimental group compared to both C1 and C2 (P<0.05), whereas no significant difference was found for treatment efficacy. Treatment outcome did not differ significantly between the experimental and two control groups. Conclusions: The findings provide partial support for the use of goal setting to enhance adherence in clinical rehabilitation

Proximate control and adaptive potential of protandrous migration in birds

Migration determines where, when, and in which order males and females converge for reproduction. Protandry, the earlier arrival of males relative to females at the site of reproduction, is a widespread phenomenon found in many migratory organisms. Detailed knowledge of the determinants of protandry is becoming increasingly important for predicting how migratory species and populations will respond to rapid phenological shifts caused by climatic change. Here, we review and discuss the potential mechanisms underlying protandrous migration in birds, focusing on evidence from passerine species. Latitudinal segregation during the non-breeding period and differences in the initiation of spring migration are probably the key determinants of protandrous arrival at the breeding sites, while sexual differences in speed of migration appear to play a minor role. Experimental evidence suggests that differences between the sexes in the onset of spring migratory activity are caused by differences in circannual rhythmicity or by photoperiodic responsiveness. Both of these mechanisms are hardwired and could prevent individuals from responding plastically to chronic changes in temperature at the breeding grounds. As a consequence, adaptive changes in both the timing of arrival in spring and of reproduction will require evolutionary (genetic) changes of the cue-response systems underlying the initiation and extent of migration in both males and female

Insulin mediated upregulation of the renin angiotensin system in human subcutaneous adipocytes is reduced by Rosiglitazone

Background: Obesity associated hypertension is likely to be due to multiple mechanisms. Identification of the renin-angiotensin system (RAS) within adipose tissue does, however, suggest a potential causal role for it in obesity-associated hypertension. Obese patients are often hyperinsulinaemic, but mechanisms underlying insulin upregulation of the RAS in adipose tissue are unclear. TNFα, an inducer of angiotensinogen in hepatocytes, is elevated in hyperinsulinaemic, obese individuals, and may provide a link in mediating insulin upregulation of the RAS in adipose tissue. Further, thiazolidinediones lower blood pressure in vivo and downregulation of the RAS in adipose tissue may contribute to this effect. We therefore examined the effect of rosiglitazone (RSG), on the insulin mediated upregulation of the RAS. Methods and Results: Sera were obtained from the arterial circulation and from venous blood draining subcutaneous abdominal adipose tissue. Isolated human abdominal subcutaneous adipocytes (n=12) were treated with insulin (1-1000nM) and insulin in combination with RSG (10nM), and RSG (10nM) alone to determine angiotensinogen expression, angiotensin II, bradykinin and TNFα secretion. Subcutaneous adipocytes were also treated with TNFα (10-100ng/mL) to examine the direct effect on angiotensinogen expression and angiotensin II secretion. The findings showed that the arterio-venous difference in angiotensin II levels was significant (↑23%; p<0.001). Insulin increased TNFα secretion in a concentration-dependent manner (p<0.01) whilst RSG (10nM) significantly reduced the insulin mediated rise in TNFα (p<0.001), as well as AGT and angiotensin II. TNFα also increased angiotensinogen and angiotensin II in isolated adipocytes. Conclusions: Our in vivo data suggest that human subcutaneous adipose tissue is a significant source of angiotensin II. This study also demonstrates a potential TNFα mediated mechanism through which insulin may stimulate the RAS and may contribute to explain obesity associated hypertension. RSG downregulates the RAS in subcutaneous adipose tissue and this effect may contribute to the long-term effect of RSG on blood pressure

The Effect of Changes in Irradiance on the Growth, Biomass, Lipid Accumulation and pigment composition of Botryococcus braunii

Light is one of the strongest factors affecting the growth and accumulation products within algae. While low irradiance brings about a reduction in biomass and productivity, exposure to high irradiance causes oxidative damage to the photosynthetic machinery. The green, colonial alga Botryococcus braunii (B. braunii) is regarded as a potential source of renewable fuel because of its ability to produce and secrete large amounts of hydrocarbons. B. braunii was cultured under a range of illumination conditions to assess the effect increasing irradiance had on growth, biomass and lipid accumulation and composition of the photosynthetic apparatus. Cells were grown in successive photobioreactor runs and exposed to irradiances of 300, 450 and 600 μmolphotons m−2 s−1 provided by an LED shroud. A fluorescent light shroud at 300 μmolphotons m−2 s−1 was also used to investigate the effect of light quality. The maximum growth rate was achieved at an intensity of 450 μmolphotons m−2 s−1. Production of botryococcene was found to be growth associated, while neutral lipid yield increased with irradiance. Extracts were compositionally identical for all illumination conditions investigated. B. braunii were shown to tolerate and acclimate to increasing light intensity by altering the composition of their photosynthetic apparatus. Although not statistically significant, growth at 450 and 600 μmolphotons m−2 s−1 resulted in a decrease in the chlorophyll content per cell. Increased accumulation of zeaxanthin and β-carotene was observed in cells cultured at 450 μmolphotons m−2 s−1 compared with those grown at 300 μmol m−2 s−1 and is consistent with their role in non-photochemical quenching and the dissipation of excess energy as heat and light (P > 0.05). Photoinhibition was observed during the third run at 450 μmolphotons m−2 s−1 and at all runs at 600 μmolphotons m−2 s−1. Excessive irradiance did not cause cell necrosis, but resulted in decreased viability of B. braunii cells due to the progressive accumulation of irreparable photodamage over successive photobioreactor runs. This was confirmed by microscopic analysis and a significant reduction in growth rate. Illumination type had no effect on the growth of B. braunii when cultured at 300 μmolphotons m−2 s−1, LED lighting did however prove to be a more reliable lighting source

Georeferenced digital photography for an objective and reproducible quantification of staging sea birds

Ein Ausbau der Windenergienutzung auf See könnte zu einem deutlichen Verlust an störungsfreien Überwinterungs- und Rastgebieten für Seevögel führen. Um die Auswirkungen von Windparks vor, während und nach ihrem Bau einschätzen zu können, werden im derzeitigen Standarduntersuchungskonzept des Bundesamtes für Seeschifffahrt und Hydrographie (BSH) neben schiffs- auch flugzeugbasierte Vogelzählungen empfohlen. Diese visuellen Transektzählungen haben jedoch methodische Nachteile. Aus der zur Arterkennung erforderlichen Flughöhe (78 m) und mit entsprechender Fluggeschwindigkeit können bei hohem Vogelaufkommen lediglich grobe Bestandskategorien geschätzt werden. Darüber hinaus üben Flugzeuge in dieser Höhe eine Scheuchwirkung auf Rastvögel aus, wodurch die Erfassbarkeit einiger Arten (v. a. Trauerenten) zusätzlich erschwert und die zu untersuchende Störwirkung von Windparks überlagert wird. In der vorliegenden Pilotstudie vergleichen wir eine herkömmliche Flugzeugtransektzählung mit einer kurz zuvor durchgeführten fotografischen Seevogelerfassung über der Wismarbucht in der deutschen Ostsee. Die fotografische Kartierung erfolgte mit einer hoch auflösenden Digitalkamera (39 Megapixel) aus 200 m Höhe. Entlang definierter Transekte wurden in regelmäßigen Abständen 415 entzerrte, maßstabsgetreue Digitalfotos (Orthofotos) aufgenommen. Die Ergebnisse dieser Studie zeigen, dass bei der herkömmlichen Flugzeugtransektzählung die Bestände von Meeresenten (Eider-, Eis-, Trauerenten) deutlich unterschätzt wurden. Die Abweichung gegenüber der fotografischen Methode variierte deutlich zwischen den Arten. Während des visuellen Zählflugs wurden ohne Korrekturfaktoren 85 % (Eiderente), 41 % (Eisente) und lediglich 2 % (Trauerente) der fotografisch nachgewiesenen Individuen erfasst. Die Ursachen für diese quantitativen Unterschiede werden diskutiert.An expansion of offshore wind energy production could lead to a significant loss of wintering and staging habitats for seabirds. To assess the impact of wind farms before, during and after their construction, the standard investigation concept of the Federal Maritime and Hydrographic Agency (BSH) currently recommends ship- and aircraft-based bird surveys. Observationbased aerial surveys, however, have methodological disadvantages: Low flight elevation (78 m), necessary for species recognition, and high flight speed in combination with large numbers of birds allow only rough population estimates. In addition, aircrafts flying at this elevation disturb resting birds, further obstructing their quantification. In this pilot study, we compared visually estimated seabird numbers collected during an aerial transect survey with numbers derived from digital aerial photographs of the same transects. The photographic survey was carried out shortly before the visual survey at a height of 200 m above sea level using a high-resolution digital camera (39 Mega pixels). 415 vertical photos corrected for geometry and scale were taken at regular intervals along defined transects. The results of this study suggest that the observational survey significantly underestimated the number of sea ducks. The difference between visual and photographic methods varied considerably among species: 85% (Common Eider, Somateria mollissima), 41% (Long-tailed Duck, Clangula hyemalis) and only 2% (Common Scoter, Melanitta nigra) of the photographically documented individuals were observed. The reasons for these quantitative differences are discussed

The effects of low-intensity blood flow restricted exercise compared with conventional resistance training on the clinical outcomes of active UK military personnel following a 3-week in-patient rehabilitation programme: protocol for a randomized controlled feasibility study

**Background** A challenge for rehabilitation practitioners lies in designing optimal exercise programmes that facilitate musculoskeletal (MSK) adaptations whilst simultaneously accommodating biological healing and the safe loading of an injured limb. A growing body of evidence supports the use of resistance training at a reduced load in combination with blood flow restriction (BFR) to enhance hypertrophic and strength responses in skeletal muscle. In-patient rehabilitation has a long tradition in the UK Military, however, the efficacy of low intensity (LI) BFR training has not been tested in this rehabilitation setting. The aims of this study are to determine (1) the feasibility of a randomised controlled trial (RCT) investigating LI-BFR training in a residential, multidisciplinary treatment programme and (2) provide preliminary data describing the within and between-group treatment effects of a LI-BFR intervention and a conventional resistance training group in military personnel. **Methods** This is a single-blind randomised controlled feasibility study. A minimum of 28 lower-limb injured UK military personnel, aged 18 to 50 years, attending rehabilitation at the UK Defence Medical Rehabilitation Centre (DMRC) will be recruited into the study. After completion of baseline measurements, participants will be randomised in a 1:1 ratio to receive 3 weeks (15 days) of intensive multidisciplinary team (MDT) in-patient rehabilitation. Group 1 will receive conventional resistance training 3 days per week. Group 2 will perform twice daily LI-BFR training. Both groups will also undertake the same common elements of the existing MDT programme. Repeat follow-up assessments will be undertaken upon completion of treatment. Group 2 participants will be asked to rate their pain response to LI-BFR training every five sessions. **Discussion** The results will provide information on the feasibility of a full-scale RCT. Recommendations for an adequately powered study to determine the efficacy of LI-BFR training during in-patient rehabilitation can then be made. The study may also provide insights into the potential effectiveness of LI-BFR training as a novel exercise modality to induce muscle adaptations in the absence of high mechanical loading of the lower-limb

Low-Load Resistance Training With Blood Flow Restriction Improves Clinical Outcomes in Musculoskeletal Rehabilitation: A Single-Blind Randomized Controlled Trial.

Background: There is growing evidence to support the use of low-load blood flow restriction (LL-BFR) exercise in musculoskeletal rehabilitation. Purpose: The purpose of this study was to evaluate the efficacy and feasibility of low-load blood flow restricted (LL-BFR) training versus conventional high mechanical load resistance training (RT) on the clinical outcomes of patient's undergoing inpatient multidisciplinary team (MDT) rehabilitation. Study design: A single-blind randomized controlled study. Methods: Twenty-eight lower-limb injured adults completed a 3-week intensive MDT rehabilitation program. Participants were randomly allocated into a conventional RT (3-days/week) or twice-daily LL-BFR training group. Outcome measurements were taken at baseline and 3-weeks and included quadriceps and total thigh muscle cross-sectional area (CSA) and volume, muscle strength [five repetition maximum (RM) leg press and knee extension test, isometric hip extension], pain and physical function measures (Y-balance test, multistage locomotion test-MSLT). Results: A two-way repeated measures analysis of variance revealed no significant differences between groups for any outcome measure post-intervention (p > 0.05). Both groups showed significant improvements in mean scores for muscle CSA/volume, 5-RM leg press, and 5-RM knee extension (p < 0.01) after treatment. LL-BFR group participants also demonstrated significant improvements in MSLT and Y-balance scores (p < 0.01). The Pain scores during training reduced significantly over time in the LL-BFR group (p = 0.024), with no adverse events reported during the study. Conclusion: Comparable improvements in muscle strength and hypertrophy were shown in LL-BFR and conventional training groups following in-patient rehabilitation. The LL-BFR group also achieved significant improvements in functional capacity. LL-BFR training is a rehabilitation tool that has the potential to induce positive adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits for whom conventional loaded RT is contraindicated. Trial Registration: ISRCTN Reference: ISRCTN63585315, dated 25 April 2017