Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial

Introduction: This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. Methods: General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation. Results: 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan. Conclusions: The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN01260600009853

The Nevados de Payachata volcanic region (18°S/69°W, N. Chile)

Subduction-related volcanism in the Nevados de Payachata region of the Central Andes at 18°S comprises two temporally and geochemically distinct phases. An older period of magmatism is represented by glaciated stratocones and ignimbrite sheets of late Miocene age. The Pleistocene to Recent phase (≤0.3 Ma) includes the twin stratovolcanoes Volcan Pomerape and Volcan Parinacota (the Nevados de Payachata volcanic group) and two small centers to the west (i. e., Caquena and Vilacollo). Both stratovolcanoes consist of an older dome-and-flow series capped by an andesitic cone. The younger cone, i. e., V. Parinacota, suffered a postglacial cone collapse producing a widespread debris-avalanche deposit. Subsequently, the cone reformed during a brief, second volcanic episode. A number of small, relatively mafic, satellitic cinder cones and associated flows were produced during the most recent activity at V. Parinacota. At the older cone, i. e., V. Pomerape, an early dome sequence with an overlying isolated mafic spatter cone and the cone-forming andesitic-dacitic phase (mostly flows) have been recognized. The two Nevados de Payachata stratovolcanoes display continuous major- and trace-element trends from high-K 2 O basaltic andesites through rhyolites (53%–76% SiO 2 ) that are well defined and distinct from those of the older volcanic centers. Petrography, chemical composition, and eruptive styles at V. Parinacota differ between pre- and post-debris-avalanche lavas. Precollapse flows have abundant amphibole (at SiO 2 > 59 wt%) and lower Mg numbers than postcollapse lavas, which are generally less silicic and more restricted in composition. Compositional variations indicate that the magmas of the Nevados de Payachata volcanic group evolved through a combination of fractional crystallization, crustal assimilation, and intratrend magma mixing. Isotope compositions exhibit only minor variations. Pb-isotope ratios are relatively low ( 206 Pb/ 204 Pb = 17.95–18.20 and 208 Pb/ 204 Pb = 38.2–38.5); 87 Sr/ 86 Sr ratios range 0.70612–0.70707, 143 Nd/ 144 Nd ratios range 0.51238–0.51230, and γ 18 O SMOW values range from + 6.8% o to + 7.6% o SMOW. A comparison with other Central Volcanic Zone centers shows that the Nevados de Payachata magmas are unusually rich in Ba (up to 1800 ppm) and Sr (up to 1700 ppm) and thus represent an unusual chemical signature in the Andean arc. These chemical and isotope variations suggest a complex petrogenetic evolution involving at least three distinct components. Primary mantle-derived melts, which are similar to those generated by subduction processes throughout the Andean arc, are modified by deep crustal interactions to produce magmas that are parental to those erupted at the surface. These magmas subsequently evolve at shallower levels through assimilation-crystallization processes involving upper crust and intratrend magma mixing which in both cases were restricted to end members of low isotopic contrast.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47805/1/445_2005_Article_BF01073587.pd

The desmosome and pemphigus

Desmosomes are patch-like intercellular adhering junctions (“maculae adherentes”), which, in concert with the related adherens junctions, provide the mechanical strength to intercellular adhesion. Therefore, it is not surprising that desmosomes are abundant in tissues subjected to significant mechanical stress such as stratified epithelia and myocardium. Desmosomal adhesion is based on the Ca2+-dependent, homo- and heterophilic transinteraction of cadherin-type adhesion molecules. Desmosomal cadherins are anchored to the intermediate filament cytoskeleton by adaptor proteins of the armadillo and plakin families. Desmosomes are dynamic structures subjected to regulation and are therefore targets of signalling pathways, which control their molecular composition and adhesive properties. Moreover, evidence is emerging that desmosomal components themselves take part in outside-in signalling under physiologic and pathologic conditions. Disturbed desmosomal adhesion contributes to the pathogenesis of a number of diseases such as pemphigus, which is caused by autoantibodies against desmosomal cadherins. Beside pemphigus, desmosome-associated diseases are caused by other mechanisms such as genetic defects or bacterial toxins. Because most of these diseases affect the skin, desmosomes are interesting not only for cell biologists who are inspired by their complex structure and molecular composition, but also for clinical physicians who are confronted with patients suffering from severe blistering skin diseases such as pemphigus. To develop disease-specific therapeutic approaches, more insights into the molecular composition and regulation of desmosomes are required

Improving our understanding of the in vivo modelling of psychotic disorders: a systematic review and meta-analysis

Psychotic disorders represent a severe category of mental disorders affecting about one percent of the population. Individuals experience a loss or distortion of contact with reality alongside other symptoms, many of which are still not adequately managed using existing treatments. While animal models of these disorders could offer insights into these disorders and potential new treatments, translation of this knowledge has so far been poor in terms of informing clinical trials and practice. The aim of this project was to improve our understanding of these pre-clinical studies and identify potential weaknesses underlying translational failure. I carried out a systematic search of the literature to provide an unbiased summary of publications reporting animal models of schizophrenia and other psychotic disorders. From these publications, data were extracted to quantify aspects of the field including reported quality of studies, study characteristics and behavioural outcome data. The latter of these data were then used to calculate estimates of efficacy using random-effects meta-analysis. Having identified 3847 publications of relevance, including 852 different methods used to induce the model, over 359 different outcomes tested in them and almost 946 different treatments reported to be administered. I show that a large proportion of studies use simple pharmacological interventions to induce their models of these disorders, despite the availability of models using other interventions that are arguably of higher translational relevance. I also show that the reported quality of these studies is low, and only 22% of studies report taking measures to reduce the risk of biases such as randomisation and blinding, which has been shown to affect the reliability of results drawn. Through this work it becomes apparent that the literature is incredibly vast for studies looking at animal models of psychotic disorders and that some of the relevant work potentially overlaps with studies describing other conditions. This means that drawing reliable conclusions from these data is affected by what is made available in the literature, how it is reported and identified in a search and the time that it takes to reach these conclusions. I introduce the idea of using computer-assisted tools to overcome one of these problems in the long term. Translation of results from studies looking at animals modelling uniquely-human psychotic disorders to clinical successes might be improved by better reporting of studies including publishing of all work carried out, labelling of studies more uniformly so that it is identifiable, better reporting of study design including improving on reporting of measures taken to reduce the risk of bias and focusing on models with greater validity to the human condition

Fear of the dark or dinner by moonlight? Reduced temporal partitioning among Africa's large carnivores.

Africa is home to the last intact guild of large carnivores and thus provides the only opportunity to investigate mechanisms of coexistence among large predator species. Strong asymmetric dominance hierarchies typically characterize guilds of large carnivores; but despite this asymmetry, subdominant species may persist alongside their stronger counterparts through temporal partitioning of habitat and resources. In the African guild, the subdominant African wild dogs and cheetahs are routinely described as diurnal and crepuscular. These activity patterns have been interpreted to result from the need to avoid encounters with the stronger, nocturnal spotted hyenas and lions. However, the idea that diel activity patterns of carnivore species are strongly shaped by competition and predation has recently been challenged by new observations. In a three-year study in the Okavango Delta, we investigated daily activity patterns and temporal partitioning for wild dogs, cheetahs, spotted hyenas and lions by fitting radio collars that continuously recorded activity bursts, to a total of 25 individuals. Analysis of activity patterns throughout the 24-h cycle revealed an unexpectedly high degree of temporal overlap among the four species. This was mainly due to the extensive and previously undescribed nocturnal activity of wild dogs and cheetahs. Their nocturnal activity fluctuated with the lunar cycle, represented up to 40% of the diel activity budget and was primarily constrained by moonlight availability. In contrast, the nocturnal activity patterns of lions and hyenas were unaffected by moonlight and remained constant over the lunar cycle. Our results suggest that other ecological factors such as optimal hunting conditions have shaped the diel activity patterns of subdominant, large predators. We suggest that they are "starvation driven" and must exploit every opportunity to obtain a meal. The benefits of activity on moonlit nights therefore offset the risks of encountering night-active predators and competitors