The effectiveness and safety of conservative interventions for positional plagiocephaly and congenital muscular torticollis: A synthesis of systematic reviews and guidance

Aim: To investigate for congenital muscular torticollis (CMT) and positional plagiocephaly (PP) the effectiveness and safety of manual therapy, repositioning and helmet therapy (PP only) using a systematic review of systematic reviews and national guidelines. Methods: We searched four major relevant databases: PubMed, Embase, Cochrane and MANTIS for research studies published between the period 1999-2019. Inclusion criteria were systematic reviews that analysed results from multiple studies and guidelines that used evidence and expert opinion to recommend treatment and care approaches. Three reviewers independently selected articles by title, abstract and full paper review, and extracted data. Selected studies were described by two authors and assessed for quality. Where possible meta-analysed data for change in outcomes (range of movement and head shape) were extracted and qualitative conclusions were assessed. Results: We found 10 systematic reviews for PP and 4 for CMT. One national guideline was found for each PP and CMT. For PP, manual therapy was found to be more effective than repositioning including tummy time (moderate to high evidence) but not better than helmet therapy (low evidence). Helmet therapy was better than usual care or repositioning (low evidence); and repositioning better than usual care (moderate to high evidence). The results for CMT showed that manual therapy in the form of practitioner-led stretching had moderate favourable evidence for increased range of movement. Advice, guidance and parental support was recommended in all the guidance to reassure parents of the favourable trajectory and nature of these conditions over time. Conclusions: Distinguishing between superiority of treatments was difficult due to the lack of standardised measurement systems, the variety of outcomes and limited high quality studies. More well powered effectiveness and efficacy studies are needed. However overall, advice and guidance on repositioning (including tummy-time) and practitioner-led stretching were low risk, potentially helpful and inexpensive interventions for parents to consider. Systematic review registration number: PROSPERO 2019 CRD42019139074. © 2020 The Author(s)

JPL IGS Analysis Center Report, 2001-2003

Three GPS orbit and clock products are currently provided by JPL for consideration by the IGS. Each differs in its latency and quality, with later results being more accurate. Results are typically available in both IGS and GIPSY formats via anonymous ftp. Current performance based on comparisons with the IGS final products is summarized. Orbit performance was determined by computing the 3D RMS difference between each JPL product and the IGS final orbits based on 15 minute estimates from the sp3 files. Clock performance was computed as the RMS difference after subtracting a linear trend based on 15 minute estimates from the sp3 files

Remote management of musculoskeletal pain: a pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice

Introduction: Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations. Objectives: This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain. Methods: Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience. Results: The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication. Conclusion: This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients. Keywords: Telehealth, Video consultation, Musculoskeletal pain, Physiotherapy, Exercise, Manual therapy, Psycholog

Upper- and mid-mantle interaction between the Samoan plume and the Tonga-Kermadec slabs

Mantle plumes are thought to play a key role in transferring heat from the core\u2013mantle boundary to the lithosphere, where it can significantly influence plate tectonics. On impinging on the lithosphere at spreading ridges or in intra-plate settings, mantle plumes may generate hotspots, large igneous provinces and hence considerable dynamic topography. However, the active role of mantle plumes on subducting slabs remains poorly understood. Here we show that the stagnation at 660 km and fastest trench retreat of the Tonga slab in Southwestern Pacific are consistent with an interaction with the Samoan plume and the Hikurangi plateau. Our findings are based on comparisons between 3D anisotropic tomography images and 3D petrological-thermo-mechanical models, which self-consistently explain several unique features of the Fiji\u2013Tonga region. We identify four possible slip systems of bridgmanite in the lower mantle that reconcile the observed seismic anisotropy beneath the Tonga slab (VSH4VSV) with thermo-mechanical calculations

Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect

Introduction While the placebo effect is increasingly recognised as a contributor to treatment effects in clinical practice, the nocebo and other undesirable effects are less well explored and likely underestimated. In the chiropractic, osteopathy and physiotherapy professions, some aspects of historical models of care may arguably increase the risk of nocebo effects. Purpose In this masterclass article, clinicians, researchers, and educators are invited to reflect on such possibilities, in an attempt to stimulate research and raise awareness for the mitigation of such undesirable effects. Implications This masterclass briefly introduces the nocebo effect and its underlying mechanisms. It then traces the historical development of chiropractic, osteopathy, and physiotherapy, arguing that there was and continues to be an excessive focus on the patient's body. Next, aspects of clinical practice, including communication, the therapeutic relationship, clinical rituals, and the wider social and economic context of practice are examined for their potential to generate nocebo and other undesirable effects. To aid reflection, a model to reflect on clinical practice and individual professions through the ‘prism’ of nocebo and other undesirable effects is introduced and illustrated. Finally, steps are proposed for how researchers, educators, and practitioners can maximise positive and minimise negative clinical context

On the equations of mathematical hydraulics

The relation between classical hydraulics and modern turbulence modelling is discussed for the case of two-dimensional open channel flow down an inclined plane. A second order turbulence model describing the flow is treated asymptotically for the parameter range F ≥ O (1), δ ≪1, β ≪1, and δ = O ( β 2 ), where F is the Froude number, δ is the aspect ratio, and β is the square root of a characteristic drag coefficient. The Chezy law formulation of mathematical hydraulics is derived as the lowest order approximation to the solution for the flow outside bore regions, and the transverse variation of the longitudinal velocity component is determined at the next stage of the analysis. It is shown that flow discontinuities calculated using the equations of mathematical hydraulics are resolved in bore regions of transverse length scale O ( H o ), where H o is the characteristic fluid depth. The bore structure is found to consist of a highly turbulent outer region with transverse length scale O ( H o ) in which the turbulence intensity is O (1), and a bottom boundary layer of transverse length scale O ( β 2 H o ), in which the turbulent stresses decrease rapidly to satisfy the bottom boundary conditions. The jump conditions of mathematical hydraulics at flow discontinuities are verified, and it is inferred that classical hydraulics provides an acceptable approximation to the flow outside bore regions for the parameter range considered in the theory.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43446/1/33_2004_Article_BF00945957.pd

Pragmatic trials of pain therapies

Pragmatic randomised clinical trials aim to directly inform clinical or health policy decision-making. Here, we systematically review methods and design of pragmatic trials of pain therapies to examine methods, identify common challenges, and areas for improvement. Seven databases were searched for pragmatic randomised controlled clinical trials which assessed pain treatment in a clinical population of adults reporting pain. All screening steps and data extractions were performed twice. Data were synthesised descriptively and correlation analyses between pre-specified trial features and PRECIS-2 (PRagmatic – Explanatory Continuum Indicator Summary 2) ratings and attrition were performed. Protocol registration: PROSPERO-ID CRD42020178954. Of 57 included trials, only 21% assessed pharmacological interventions, the remainder physical, surgical, psychological or self-management pain therapies. Three-quarters of the trials were comparative effectiveness designs, often conducted in multiple centres (median: 5; Q1/3: 1, 9.25) and with a median sample size of 234 patients at randomization (Q1/3: 135.5; 363.5). Although most trials recruited chronic pain patients, reporting of pain duration was poor and not well described. Reporting was comprehensive for most general items, while often deficient for specific pragmatic aspects. Average ratings for pragmatism were highest for treatment adherence flexibility and clinical relevance of outcome measures. They were lowest for patient recruitment methods and extent of follow-up measurements and appointments. Current practice in pragmatic trials of pain treatments can be improved in areas such as patient recruitment and reporting of methods, analysis and interpretation of data. These improvements will facilitate translatability to other real-world settings – the purpose of pragmatic trials