The Prevalence and Clinical Implications of Comorbid Back Pain in Shoulder Instability: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study.

Background:Understanding predictors of pain is critical, as recent literature shows that comorbid back pain is an independent risk factor for worse functional and patient-reported outcomes (PROs) as well as increased opioid dependence after total joint arthroplasty. Purpose/Hypothesis:The purpose of this study was to evaluate whether comorbid back pain would be predictive of pain or self-reported instability symptoms at the time of stabilization surgery. We hypothesized that comorbid back pain will correlate with increased pain at the time of surgery as well as with worse scores on shoulder-related PRO measures. Study Design:Cross-sectional study; Level of evidence, 3. Methods:As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative PRO scores, and radiologic and intraoperative findings were recorded for patients undergoing surgical shoulder stabilization. Patients were also asked, whether they had any back pain. Results:The study cohort consisted of 1001 patients (81% male; mean age, 24.1 years). Patients with comorbid back pain (158 patients; 15.8%) were significantly older (28.1 vs 23.4 years; P < .001) and were more likely to be female (25.3% vs 17.4%; P = .02) but did not differ in terms of either preoperative imaging or intraoperative findings. Patients with self-reported back pain had significantly worse preoperative pain and shoulder-related PRO scores (American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index) (P < .001), more frequent depression (22.2% vs 8.3%; P < .001), poorer mental health status (worse scores for the RAND 36-Item Health Survey Mental Component Score, Iowa Quick Screen, and Personality Assessment Screener) (P < .01), and worse preoperative expectations (P < .01). Conclusion:Despite having similar physical findings, patients with comorbid back pain had more severe preoperative pain and self-reported symptoms of instability as well as more frequent depression and lower mental health scores. The combination of disproportionate shoulder pain, comorbid back pain and mental health conditions, and inferior preoperative expectations may affect not only the patient's preoperative state but also postoperative pain control and/or postoperative outcomes

Movement velocity as a measure of exercise intensity in three lower limb exercises

The purpose of this study was to investigate the relationship between movement velocity and relative load in three lower limbs exercises commonly used to develop strength: Leg Press, Full Squat, and Half Squat. The percentage of one Repetition Maximum (%1RM) has typically been used as the main parameter to control resistance training, however more recent research has proposed movement velocity as an alternative. Fifteen participants performed a load progression with a range of loads until they reached their one repetition maximum (1RM). Maximum instantaneous velocity V max) and mean propulsive velocity (MPV) of the knee extension phase of each exercise were assessed. For all exercises, a strong relationship between V max and the %1RM was found: Leg Press (r2adj=0.96; 95% CI for slope is [-0.0244,-0.0258], p<0.0001), Full Squat (r2adj=0.94; 95% CI for slope is [-0.0144, -0.0139], p<0.0001), and Half Squat (r2adj=0.97; 95% CI for slope is [-0.0135, -0.00143], p<0.0001), and for MPV, Leg Press (r2adj=0.96; 95% CI for slope is [- 0.0169, -0.0175], p<0.0001, Full Squat (r2adj=0.95; 95% CI for slope is [-0.0136, -0.0128], p<0.0001), and Half Squat (r2adj=0.96; 95% CI for slope is [-0.0116, 0.0124], p<0.0001). The 1RM was attained with a MPV and Vmax of 0.21±0.06 ms-1 and 0.63±0.15 ms-1, 0.29±0.05 ms-1 and 0.89±0.17 ms-1, 0.33±0.05 ms-1, and 0.95±0.13 ms-1 for Leg Press, Full Squat and Half Squat respectively. Results indicate that it is possible to determine an exercise-specific %1RM by measuring movement velocity for that exercise

Posthumous Medical Data Donation: The Case for a Legal Framework

This article explores the options for establishing a legal framework for posthumous medical data donation (PMDD). This concept has not been discussed in legal scholarship to date at all. The paper is, therefore, a first legal study of PMDD, aiming to address the gap and shed light on the most significant legal issues that could affect this concept. The paper starts by looking at the protection of the deceased’s health records and medical data, finding that this protection in law is more extensive than the general protection of the deceased’s personal data, or the protection of post-mortem privacy as a concept. The paper then investigates key issues around ownership and succession of personal data, including medical and health-related data, and how these could affect PMDD and its legal framework. The author then goes on to explore some parallels with organ donation to determine whether there are some lessons to be learned from this comparable regulatory framework. The paper concludes with the discussion around the need for a Code for posthumous medical data donation developed by the Digital Ethics Lab at the Oxford Internet Institute, and a more formal regime that would enable and facilitate this practice. Here, the author proposes key law reforms in the area of data protection and governance related to PMDD. These reforms would include amendments to the general data protection ideally, to ensure harmonisation and consistency across the EU, as well as between the general and sector-specific data protection laws and policies. These changes would contribute to legal and regulatory clarity and would help implement this important and valuable practice, which aims to facilitate research and advances in medical treatments and care

The Cosmic Microwave Background and Particle Physics

In forthcoming years, connections between cosmology and particle physics will be made increasingly important with the advent of a new generation of cosmic microwave background (CMB) experiments. Here, we review a number of these links. Our primary focus is on new CMB tests of inflation. We explain how the inflationary predictions for the geometry of the Universe and primordial density perturbations will be tested by CMB temperature fluctuations, and how the gravitational waves predicted by inflation can be pursued with the CMB polarization. The CMB signatures of topological defects and primordial magnetic fields from cosmological phase transitions are also discussed. Furthermore, we review current and future CMB constraints on various types of dark matter (e.g. massive neutrinos, weakly interacting massive particles, axions, vacuum energy), decaying particles, the baryon asymmetry of the Universe, ultra-high-energy cosmic rays, exotic cosmological topologies, and other new physics.Comment: 43 pages. To appear in Annual Reviews of Nuclear and Particle Scienc

Detailing patient specific modelling to aid clinical decision-making

The anatomy of the craniofacial skeleton has been described through the aid of dissection identifying hard and soft tissue structures. Although the macro and microscopic investigation of internal facial tissues have provided invaluable information on constitution of the tissues it is important to inspect and model facial tissues in the living individual. Detailing the form and function of facial tissues will be invaluable in clinical diagnoses and planned corrective surgical interventions such as management of facial palsies and craniofacial disharmony/anomalies. Recent advances in lower-cost, non-invasive imaging and computing power (surface scanning, Cone Beam Computerized Tomography (CBCT) and Magnetic Resonance (MRI)) has enabled the ability to capture and process surface and internal structures to a high resolution. The three-dimensional surface facial capture has enabled characterization of facial features all of which will influence subtleties in facial movement and surgical planning. This chapter will describe the factors that influence facial morphology in terms of gender and age differences, facial movement—surface and underlying structures, modeling based on average structures, orientation of facial muscle fibers, biomechanics of movement—proof of principle and surgical intervention

Shower Power: Isolating the Prompt Atmospheric Neutrino Flux Using Electron Neutrinos

At high energies, the very steep decrease of the conventional atmospheric component of the neutrino spectrum should allow the emergence of even small and isotropic components of the total spectrum, indicative of new physics, provided that they are less steeply decreasing, as generically expected. One candidate is the prompt atmospheric neutrino flux, a probe of cosmic ray composition in the region of the knee as well as small-$x$ QCD, below the reach of collider experiments. A second is the diffuse extragalactic background due to distant and unresolved AGNs and GRBs, a key test of the nature of the highest-energy sources in the universe. Separating these new physics components from the conventional atmospheric neutrino flux, as well as from each other, will be very challenging. We show that the charged-current {\it electron} neutrino "shower" channel should be particularly effective for isolating the prompt atmospheric neutrino flux, and that it is more generally an important complement to the usually-considered charged-current {\it muon} neutrino "track" channel. These conclusions remain true even for the low prompt atmospheric neutrino flux predicted in a realistic cosmic ray scenario with heavy and varying composition across the knee (Candia and Roulet, 2003 JCAP {\bf 0309}, 005). We also improve the corresponding calculation of the neutrino flux induced by cosmic ray collisions with the interstellar medium.Comment: 15 pages, 4 figures. Minor modifications, version accepted for publication in JCA

SOX10 directly modulates ERBB3 transcription via an intronic neural crest enhancer

<p>Abstract</p> <p>Background</p> <p>The <it>ERBB3 </it>gene is essential for the proper development of the neural crest (NC) and its derivative populations such as Schwann cells. As with all cell fate decisions, transcriptional regulatory control plays a significant role in the progressive restriction and specification of NC derived lineages during development. However, little is known about the sequences mediating transcriptional regulation of <it>ERBB3 </it>or the factors that bind them.</p> <p>Results</p> <p>In this study we identified three transcriptional enhancers at the <it>ERBB3 </it>locus and evaluated their regulatory potential <it>in vitro </it>in NC-derived cell types and <it>in vivo </it>in transgenic zebrafish. One enhancer, termed <it>ERBB3</it>_MCS6, which lies within the first intron of <it>ERBB3</it>, directs the highest reporter expression <it>in vitro </it>and also demonstrates epigenetic marks consistent with enhancer activity. We identify a consensus SOX10 binding site within <it>ERBB3</it>_MCS6 and demonstrate, <it>in vitro</it>, its necessity and sufficiency for the activity of this enhancer. Additionally, we demonstrate that transcription from the endogenous <it>Erbb3 </it>locus is dependent on Sox10. Further we demonstrate <it>in vitro </it>that Sox10 physically interacts with that <it>ERBB3</it>_MCS6. Consistent with its <it>in vitro </it>activity, we also show that <it>ERBB3</it>_MCS6 drives reporter expression in NC cells and a subset of its derivative lineages <it>in vivo </it>in zebrafish in a manner consistent with <it>erbb3b </it>expression. We also demonstrate, using morpholino analysis, that Sox10 is necessary for <it>ERBB3</it>_MCS6 expression <it>in vivo </it>in zebrafish.</p> <p>Conclusions</p> <p>Taken collectively, our data suggest that <it>ERBB3 </it>may be directly regulated by SOX10, and that this control may in part be facilitated by <it>ERBB3</it>_MCS6.</p

From chemical gardens to chemobrionics

Chemical gardens in laboratory chemistries ranging from silicates to polyoxometalates, in applications ranging from corrosion products to the hydration of Portland cement, and in natural settings ranging from hydrothermal vents in the ocean depths to brinicles beneath sea ice. In many chemical-garden experiments, the structure forms as a solid seed of a soluble ionic compound dissolves in a solution containing another reactive ion. In general any alkali silicate solution can be used due to their high solubility at high pH. The cation should not precipitate with the counterion of the metal salt used as seed. A main property of seed chemical-garden experiments is that initially, when the fluid is not moving under buoyancy or osmosis, the delivery of the inner reactant is diffusion controlled. Another experimental technique that isolates one aspect of chemical-garden formation is to produce precipitation membranes between different aqueous solutions by introducing the two solutions on either side of an inert carrier matrix. Chemical gardens may be grown upon injection of solutions into a so-called Hele-Shaw cell, a quasi-two-dimensional reactor consisting in two parallel plates separated by a small gap