The Neuromuscular Response to Spinal Manipulation: Quantifying the Effect of Pain with Electromyography

Objective To establish a methodology to quantify the neuromuscular response to spinal manipulation, develop a comprehensive date set including factors that affect the response, and compare the responses in both healthy participants and participants with acute and chronic low back pain. Methods Surface and indwelling electromyography at eight muscle locations were recorded during lumbar side-lying manipulations in 20 asymptomatic participants, 20 acute pain participants, and 20 chronic pain participants. Onset delay detection was optimized for signal detection failures and methodological comparisons were performed using a generalized linear model. The number of muscle responses and muscle activity onset delays in relation to the manipulation contact force were compared across participant subclasses using mixed linear regressions. Effect sizes for all comparisons were calculated using Cohen\u27s d. Results The method of muscle activity onset delay detection that best characterized the neuromuscular response to spinal manipulation was the double-threshold method with parameters of an 8 standard deviation amplitude threshold and a 10-msec duration threshold. In healthy participants, factors such as manipulation order and location had little effect on the neuromuscular response; however, the responding muscle location, layer and side revealed tendencies of lower response rates, and longer muscle activity onset delays as the distance from the manipulation location increased. Symptomatic participants had less muscle responses and longer muscle activity onset delays than the asymptomatic participants. Chronic pain participants had a greater tendency for shorter muscle activity onset delays than acute pain participants. Conclusions This study establishes a comprehensive database of both superficial lumbar and deep multifidus muscle activity and timing during spinal manipulation. The double-threshold method of muscle activity onset delay calculation is recommended over the cross-correlation method. Future studies in healthy participants focused on timing outcomes can be designed without regard for manipulation order and location within the parameters used in this study. Spinal manipulation may mediate pain through its influence on afferent activity of the muscle spindles and central nervous system. Participants in pain may experience more excitability in slower capsular reflex pathways than faster muscle spindle pathways compared to healthy participants, with the influence of the multifidi providing more pain-gating input to the central nervous system than superficial muscles. The neuromuscular response to spinal manipulation in participants in pain is dominated by the multifidus and is consistent with passive movements, as opposed to active movements that are dominated by superficial muscles

Alcohol Induces Sensitization to Gluten in Genetically Susceptible Individuals: A Case Control Study

Background: The mechanisms of cerebellar degeneration attributed to prolonged and excessive alcohol intake remain unclear. Additional or even alternative causes of cerebellar degeneration are often overlooked in suspected cases of alcohol-related ataxia. The objectives of this study were two fold: (1) to investigate the prevalence of gluten-related serological markers in patients with alcohol-related ataxia and; (2) to compare the pattern of brain involvement on magnetic resonance imaging between patients with alcohol and gluten ataxias. Materials & Methods: Patients diagnosed with alcohol and gluten ataxias were identified from a retrospective review of patients attending a tertiary clinic. HLA genotype and serological markers of gluten-related disorders were recorded. Cerebellar volumetry, MR spectroscopy and voxel-based morphometric analyses were performed on patients and compared with matched control data. Results: Of 904 registered patients, 104 had alcohol ataxia and 159 had gluten ataxia. 61% of the alcohol ataxia group and 70% of the gluten ataxia group had HLA DQ2/DQ8 genotype compared to 30% in healthy local blood donors. 44% of patients with alcohol ataxia had antigliadin antibodies compared to 12% in the healthy local population and 10% in patients with genetically confirmed ataxias. None of the patients with alcohol ataxia and antigliadin antibodies had celiac disease compared to 40% in patients with gluten ataxia. The pattern of structural brain abnormality in patients with alcohol ataxia who had antigliadin antibodies differed from gluten ataxia and was identical to that of alcohol ataxia. Conclusions: Alcohol related cerebellar degeneration may, in genetically susceptible individuals, induce sensitization to gluten. Such sensitization may result from a primary cerebellar insult, but a more systemic effect is also possible. The duration and amount of exposure to alcohol may not be the only factors responsible for the cerebellar insult

Neutral and Charged Polymers at Interfaces

Chain-like macromolecules (polymers) show characteristic adsorption properties due to their flexibility and internal degrees of freedom, when attracted to surfaces and interfaces. In this review we discuss concepts and features that are relevant to the adsorption of neutral and charged polymers at equilibrium, including the type of polymer/surface interaction, the solvent quality, the characteristics of the surface, and the polymer structure. We pay special attention to the case of charged polymers (polyelectrolytes) that have a special importance due to their water solubility. We present a summary of recent progress in this rapidly evolving field. Because many experimental studies are performed with rather stiff biopolymers, we discuss in detail the case of semi-flexible polymers in addition to flexible ones. We first review the behavior of neutral and charged chains in solution. Then, the adsorption of a single polymer chain is considered. Next, the adsorption and depletion processes in the many-chain case are reviewed. Profiles, changes in the surface tension and polymer surface excess are presented. Mean-field and corrections due to fluctuations and lateral correlations are discussed. The force of interaction between two adsorbed layers, which is important in understanding colloidal stability, is characterized. The behavior of grafted polymers is also reviewed, both for neutral and charged polymer brushes.Comment: a review: 130 pages, 30 ps figures; final form, added reference

"Go make your face known": collaborative working through the lens of personal relationships

Background: Collaborative working between professionals is a key component of integrated care. The academic literature on it largely focuses either on integration between health and social care or on the dynamics of power and identity between doctors and nurses. With the proliferation and extension of nursing roles, there is a need to examine collaborative working amongst different types of nurses. Method: This study explored experiences of collaborative working amongst generalist and specialist nurses, in community and acute settings. We carried out semi-structured interviews, incorporating the Pictor technique, with 45 nurses, plus 33 other key stakeholders. Transcripts were analysed using Template Analysis. This article focuses on one major thematic area that emerged from the analysis: the significance of interpersonal relationships amongst nurses, and between them and other professionals, patients and carers. Results: Relationship issues were ubiquitous in participants’ accounts of collaborative working. Good personal relationships facilitated collaboration; face-to-face interaction was especially valued. Relationships were recognized as requiring effort, especially in new roles. Organisational changes could disrupt productive personal networks. Conclusion: Relationship issues are integral to successful collaborative working. Policy and practice leaders must take this into account in future service developments. Further research into collaborative relationships in different settings is needed

Accurate stationary densities with partitioned numerical methods for stochastic partial differential equations

We consider the numerical solution, by finite differences, of second-order-in-time stochastic partial differential equations (SPDEs) in one space dimension. New timestepping methods are introduced by generalising recently-introduced methods for second-order-in-time stochastic differential equations to multidimensional systems. These stochastic methods, based on leapfrog and Runge–Kutta methods, are designed to give good approximations to the stationary variances and the correlations in the position and velocity variables. In particular, we introduce the reverse leapfrog method and stochastic Runge–Kutta Leapfrog methods, analyse their performance applied to linear SPDEs and perform numerical experiments to examine their accuracy applied to a type of nonlinear SPDE

Liver Development, Regeneration, and Carcinogenesis

The identification of putative liver stem cells has brought closer the previously separate fields of liver development, regeneration, and carcinogenesis. Significant overlaps in the regulation of these processes are now being described. For example, studies in embryonic liver development have already provided the basis for directed differentiation of human embryonic stem cells and induced pluripotent stem cells into hepatocyte-like cells. As a result, the understanding of the cell biology of proliferation and differentiation in the liver has been improved. This knowledge can be used to improve the function of hepatocyte-like cells for drug testing, bioartificial livers, and transplantation. In parallel, the mechanisms regulating cancer cell biology are now clearer, providing fertile soil for novel therapeutic approaches. Recognition of the relationships between development, regeneration, and carcinogenesis, and the increasing evidence for the role of stem cells in all of these areas, has sparked fresh enthusiasm in understanding the underlying molecular mechanisms and has led to new targeted therapies for liver cirrhosis and primary liver cancers

Gaelic and identity:A response to Iain MacKinnon

This article responds to the recent special issue of Scottish Affairs on ‘Gàidhealtachd Futures’ and in particular the article by Iain MacKinnon proposing that ancestry, ethnicity and indigeneity should become the principal elements in contemporary Gaelic identity. The editors of the special issue do not give an analytically meaningful presentation of the term Gàidhealtachd and MacKinnon fails to give a complete or balanced account of previous research on the question of Gaelic identity. There is considerable uncertainty about how the term Gael is understood today; many Gaelic speakers are reluctant to accept this label for themselves. MacKinnon's arguments concerning the role of ancestry in defining Gaelic identity are highly problematic in both analytical and political terms. His proposals concerning ethnicity and indigeneity are unsustainable, particularly in light of relevant legal standards, and amount to a strategic, ethical and legal dead end for the Gaelic revitalisation movement

Against exclusionary Gaelic language policy:A response to Ó Giollagáin and Caimbeul

This article considers a range of weaknesses and deficiencies in the article ‘Moving Beyond Asocial Minority-Language Policy’ by Conchúr Ó Giollagáin and Iain Caimbeul and the underlying research study on which it was based. The authors’ presentation of previous research was inadequate and the framing of their survey results was sensationalistic, risking the demoralisation of Gaelic speakers and the weakening of social or political support for the language. The authors fail to justify and properly define the key terms used in their analysis, including ‘vernacular community’ and ‘Gaelic group’, so that there is a pervasive lack of clarity to their discussion, with serious implications for their key policy proposal. We also identify shortcomings in the geographic framing of their study; which areas were included and which were not. We then challenge the social classification they use in their analysis, and their rigid distinction between Gaelic speakers in their study area and all those living elsewhere. We then demonstrate how the authors’ presentation of current Gaelic policy is incomplete, misleading and biased, and we critique their proposals for fundamental changes to the current policy structure, including the creation of a new Gaelic community trust. We argue that strengthening existing policy structures and exploiting such structures much more energetically and effectively offers a better approach to strengthening the language, both in the areas studied and elsewhere in the country

Consensus Paper: Radiological Biomarkers of Cerebellar Diseases

Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine