Facet joint injections for people with persistent non-specific low back pain (Facet injection study) : A feasibility study for a randomised controlled trial

All NIHR Journals Library reports have been produced under the terms of a commissioning contract issued by the Secretary of State for Health. Reports may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Permission to reproduce material from a published report is covered by the UK government’s non-commercial licence for public sector information. Applications for commercial reproduction should be addressed to the editorial office at: [email protected]: The National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care. Objectives: To explore the feasibility of running a RCT to test the hypothesis that, for people with suspected facet joint back pain, adding the option of intra-articular FJIs (local anaesthetic and corticosteroids) to best usual non-invasive care is clinically effective and cost-effective. Design: The trial was a mixed design. The RCT pilot protocol development involved literature reviews and a consensus conference followed by a randomised pilot study with an embedded mixed-methods process evaluation. Setting: Five NHS acute trusts in England. Participants: Participants were patients aged ≥ 18 years with moderately troublesome LBP present (> 6 months), who had failed previous conservative treatment and who had suspected facet joint pain. The study aimed to recruit 150 participants (approximately 30 per site). Participants were randomised sequentially by a remote service to FJIs combined with ‘best usual care’ (BUC) or BUC alone. Interventions: All participants were to receive six sessions of a bespoke BUC rehabilitation package. Those randomised into the intervention arm were, in addition, given FJIs with local anaesthetic and steroids (at up to six injection sites). Randomisation occurred at the end of the first BUC session. Main outcome measures: Process and clinical outcomes. Clinical outcomes included a measurement of level of pain on a scale from 0 to 10, which was collected daily and then weekly via text messaging (or through a written diary). Questionnaire follow-up was at 3 months. Results: Fifty-two stakeholders attended the consensus meeting. Agreement informed several statistical questions and three design considerations: diagnosis, the process of FJI and the BUC package and informing the design for the randomised pilot study. Recruitment started on 26 June 2015 and was terminated by the funder (as a result of poor recruitment) on 11 December 2015. In total, 26 participants were randomised. Process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly. No between-group analysis was carried out. All pain-related outcomes show the expected improvement between baseline and follow-up. The mean total cost of the overall treatment package (injection £419.22 and BUC £264.00) was estimated at £683.22 per participant. This is similar to a NHS tariff cost for a course of FJIs of £686.84. Limitations: Poor recruitment was a limiting factor. Conclusions: This feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain.Peer reviewe

Photochemistry of Transition Metal Complexes Induced by Outer-Sphere Charge Transfer Excitation

The intermolecular (outer sphere, OS) interaction of a reducing and an oxidizing metal complex generates a new optical transition involving charge transfer (CT) from the electron donor to the acceptor. OS CT transitions are classified according to the redox site (metal or ligand). Generally, the interaction between donor and acceptor is facilitated by ion pairs consisting of an oxidizing complex cation and a reducing complex anion. There are also ion pairs which are composed of a metal complex and an organic counter ion as electron donor or acceptor. In addition, the review includes examples of OS CT interaction which do not involve ion pairs at all. — A short introduction into the theory is followed by the discussion of the spectroscopy of OS CT of transition metal complexes. Finally, photoreactions induced by OS CT transitions are reviewed. The optical transfer is frequently followed by a rapid back electron transfer which regenerates the starting complexes. In many cases the primary products are kinetically labile and substitution reactions compete successfully with back electron transfer. As a result stable redox products may be formed. As an alternative, the substitution can be followed by back electron transfer. Product formation appears then as a substitution of the starting complexes. The various possibilities are illustrated by appropriate examples

Fitness Landscape Analysis of Weight-Elimination Neural Networks

Neural network architectures can be regularised by adding a penalty term to the objective function, thus minimising network complexity in addition to the error. However, adding a term to the objective function inevitably changes the surface of the objective function. This study investigates the landscape changes induced by the weight elimination penalty function under various parameter settings. Fitness landscape metrics are used to quantify and visualise the induced landscape changes, as well as to propose sensible ranges for the regularisation parameters. Fitness landscape metrics are shown to be a viable tool for neural network objective function landscape analysis and visualisation.The National Research Foundation (NRF) of South Africa (Grant Number 46712).https://link.springer.com/journal/110632019-08-01hj2018Consumer Scienc