Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders

<p>Abstract</p> <p>Background</p> <p>Low back disorders are a common and costly cause of pain and activity limitation in adults. Few treatment options have demonstrated clinically meaningful benefits apart from advice which is recommended in all international guidelines. Clinical heterogeneity of participants in clinical trials is hypothesised as reducing the likelihood of demonstrating treatment effects, and sampling of more homogenous subgroups is recommended. We propose five subgroups that allow the delivery of specific physiotherapy treatment targeting the pathoanatomical, neurophysiological and psychosocial components of low back disorders. The aim of this article is to describe the methodology of a randomised controlled trial comparing specific physiotherapy treatment to advice for people classified into five subacute low back disorder subgroups.</p> <p>Methods/Design</p> <p>A multi-centre parallel group randomised controlled trial is proposed. A minimum of 250 participants with subacute (6 weeks to 6 months) low back pain and/or referred leg pain will be classified into one of five subgroups and then randomly allocated to receive either physiotherapy advice (2 sessions over 10 weeks) or specific physiotherapy treatment (10 sessions over 10 weeks) tailored according to the subgroup of the participant. Outcomes will be assessed at 5 weeks, 10 weeks, 6 months and 12 months following randomisation. Primary outcomes will be activity limitation measured with a modified Oswestry Disability Index as well as leg and back pain intensity measured on separate 0-10 Numerical Rating Scales. Secondary outcomes will include a 7-point global rating of change scale, satisfaction with physiotherapy treatment, satisfaction with treatment results, the Sciatica Frequency and Bothersomeness Scale, quality of life (EuroQol-5D), interference with work, and psychosocial risk factors (Orebro Musculoskeletal Pain Questionnaire). Adverse events and co-interventions will also be measured. Data will be analysed according to intention to treat principles, using linear mixed models for continuous outcomes, Mann Whitney U tests for ordinal outcomes, and Chi-square, risk ratios and risk differences for dichotomous outcomes.</p> <p>Discussion</p> <p>This trial will determine the difference in outcomes between specific physiotherapy treatment tailored to each of the five subgroups versus advice which is recommended in guidelines as a suitable treatment for most people with a low back disorder.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12609000834257.aspx">ACTRN12609000834257</a>.</p

Basisdocument Cadmium

Betreft de engelse editie van rapport nr. 758476002. Bij dit rapport behoort een bijlage getiteld Integrated Criteria Document Cadmium, Effects, met rapportnummer 758476004&lt;br&gt;Dit rapport bevat een systematisch overzicht en een kritische evaluatie van de belangrijkste gegevens over de prioritaire stof cadmium ten behoeve van het effectgericht milieubeleid.DGM/SR /Cornet J

Integrated criteria document cadmium

De engelse versie van dit rapport is verschenen onder nummer 758476004. Bij dit rapport hoort een appendix met hetzelfde rapportnummer 758476002.&lt;br&gt;Onderhavig document omvat gegevens over cadmium inzake de bronnen en het verspreidingspatroon (bodem, water, lucht, biota), de risico's op basis van afweging van blootstellingsconcentraties voor de mens, (onderdelen van) ecosystemen en materialen anderszijds, en de technische mogelijkheden en economische gevolgen m.b.t. reductie van deze risico's. Deze informatie dient als wetenschappelijke basis voor het formuleren van het effectgericht normstellingbeleid.-DGMH/BWS-S / Cornet JPWijnen HLJ

Potential of Extensification of European and Dutch Agriculture for a More Sustainable Food System Focusing on Nitrogen and Livestock

Most global strategies for future food security focus on sustainable intensification of production of food and involve an increase of nitrogen (N) fertilizer use, livestock production and risk of N pollution. In this chapter, we explore the potential of sustainable extensification for agriculture in the European Union (EU) and the Netherlands by analyzing cases and scenario studies focusing on reducing N inputs and livestock densities. Benefits of extensification to society include higher local biodiversity and less environmental pollution. Societal costs of N losses in the EU from agriculture are substantial and for 2008 are here estimated at 0.3-1.9% of the gross domestic product (GDP). Extensification also has risks such as a reduction of yields and therewith a decrease of both GDP and farm income. This also implies a smaller contribution to global food production and, potentially, an increase of global demand for land. For N-intensive agricultural systems in northwest EU, a reduction of N fertilization rate and livestock densities of up to 30% would reduce the external cost of N pollution to such an extent that society as a whole would benefit. However, compensation would be needed for net loss of farm income, e.g., by price premiums for cleaner production or improved animal welfare. Extensification scenarios with > 30% decrease of livestock production would require adjustment of human diets. A 2030 scenario for the EU halving consumption and production of animal products (demitarian diet) is here estimated to reduce N pollution by 10%, benefits human health and would transform the EU from a feed importer to a food exporter

Search for charginos, neutralinos and gravitinos at LEP

An update of the searches for charginos and neutralinos in DELPHI is presented, based mainly on recent data collected at centre-of-mass energies of 161 GeV and 172 GeV. No signal is found. For a sneutrino with mass above 300 GeV/c(2) and a mass difference between the chargino and the lightest neutralino above 10 GeV/c(2), the lower limit at 95% confidence level on the chargino mass ranges from 84.3 GeV/c(2) to the kinematical limit (86.0 GeV/c(2)), depending on the mixing parameters. The limit, decreases for lower chargino-neutralino mass differences. The limit in the case of a light sneutrino is 67.6 GeV/c(2), provided that that there is no light sneutrino with a mass within 10 GeV/c(2) below the chargino mass. Upper limits on neutralino pair production cross-sections of about a picobarn are derived. The (mu, M-2) domain excluded in the MSSM-GUT scenario is determined by combining the neutralino and chargino searches. These results imply a limit. on the mass of the lightest neutralino which, for a heavy sneutrino, is constrained to be above 24.9 GeV/c(2) for tan beta greater than or equal to 1. The search has also been extended to the case where the lightest neutralino is unstable and decays into a photon and a gravitino