A systematic review highlights the need to improve the quality and applicability of trials of physical therapy interventions for low back pain

Objectives: The objective of this study was to review and assess the methodological quality of randomized controlled trials that test physical therapy interventions for low back pain. Study Design and Setting: This is a systematic review of trials of physical therapy interventions to prevent or treat low back pain (of any duration or type) in participants of any age indexed on the Physiotherapy Evidence Database (PEDro). Existing PEDro scale ratings were used to evaluate methodological quality. Results: This review identified 2,215 trials. The majority of trials were for adults (n = 2136, 96.4%), low back pain without specific etiology (n = 1,863, 84.1%), and chronic duration (n = 947, 42.8%). The quality of trials improved over time; however, most were at risk of bias. Less than half of the trials concealed allocation to intervention (n = 813, 36.7%), used intention-to-treat principles (n = 778, 35.1%), and blinded assessors (n = 810, 36.6%), participants (n = 174, 7.9%), and therapists (n = 39, 1.8%). These findings did not vary by the type of therapy. Conclusion: Most trials that test physical therapy interventions for low back pain have methodological limitations that could bias treatment effect estimates. Greater attention to methodological features, such as allocation concealment and the reporting of intention-to-treat effects, would improve the quality of trials testing physical therapy interventions for low back pain

Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: Systematic review and meta-analysis

AbstractObjective To investigate the efficacy, acceptability, and safety of muscle relaxants for low back pain. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Medline, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and WHO ICTRP from inception to 23 February 2021. Eligibility criteria for study selection Randomised controlled trials of muscle relaxants compared with placebo, usual care, waiting list, or no treatment in adults (≥18 years) reporting non-specific low back pain. Data extraction and synthesis Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty of the evidence using the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development and Evaluations, respectively. Random effects meta-analytical models through restricted maximum likelihood estimation were used to estimate pooled effects and corresponding 95% confidence intervals. Outcomes included pain intensity (measured on a 0-100 point scale), disability (0-100 point scale), acceptability (discontinuation of the drug for any reason during treatment), and safety (adverse events, serious adverse events, and number of participants who withdrew from the trial because of an adverse event). Results 49 trials were included in the review, of which 31, sampling 6505 participants, were quantitatively analysed. For acute low back pain, very low certainty evidence showed that at two weeks or less non-benzodiazepine antispasmodics were associated with a reduction in pain intensity compared with control (mean difference -7.7, 95% confidence interval-12.1 to-3.3) but not a reduction in disability (-3.3, -7.3 to 0.7). Low and very low certainty evidence showed that non-benzodiazepine antispasmodics might increase the risk of an adverse event (relative risk 1.6, 1.2 to 2.0) and might have little to no effect on acceptability (0.8, 0.6 to 1.1) compared with control for acute low back pain, respectively. The number of trials investigating other muscle relaxants and different durations of low back pain were small and the certainty of evidence was reduced because most trials were at high risk of bias. Conclusions Considerable uncertainty exists about the clinical efficacy and safety of muscle relaxants. Very low and low certainty evidence shows that non-benzodiazepine antispasmodics might provide small but not clinically important reductions in pain intensity at or before two weeks and might increase the risk of an adverse event in acute low back pain, respectively. Large, high quality, placebo controlled trials are urgently needed to resolve uncertainty. Systematic review registration PROSPERO CRD42019126820 and Open Science Framework https://osf.io/mu2f5/

A new species of Brachycephalus (Anura: Brachycephalidae) from the northern portion of the state of Rio de Janeiro, southeastern Brazil

Abstract Brachycephalus is a genus of small ground-dwelling anurans, endemic to the Brazilian Atlantic Forest. Recent molecular analyses have corroborated the monophyly of three species groups within this genus (B. ephippium, B. ephippium, and B. ephippium). In the meantime, the genus has been targeted as a group with recent taxonomic issues owing to its interspecific morphological similarity and genetic conservatism. Herein, we describe a new species of Brachycephalus from the northern portion of Serra do Mar mountain range, in the state of Rio de Janeiro, Brazil. It belongs to the B. ephippium species group, exhibiting moderate hyperossification of the skull and vertebral column. The new species can be distinguished from all other congeners based on morphological, acoustic, and molecular data. Furthermore, we provide information on osteology and natural history of the new species

Dengue-2 Structural Proteins Associate with Human Proteins to Produce a Coagulation and Innate Immune Response Biased Interactome

<p>Abstract</p> <p>Background</p> <p>Dengue virus infection is a public health threat to hundreds of millions of individuals in the tropical regions of the globe. Although Dengue infection usually manifests itself in its mildest, though often debilitating clinical form, dengue fever, life-threatening complications commonly arise in the form of hemorrhagic shock and encephalitis. The etiological basis for the virus-induced pathology in general, and the different clinical manifestations in particular, are not well understood. We reasoned that a detailed knowledge of the global biological processes affected by virus entry into a cell might help shed new light on this long-standing problem.</p> <p>Methods</p> <p>A bacterial two-hybrid screen using DENV2 structural proteins as bait was performed, and the results were used to feed a manually curated, global dengue-human protein interaction network. Gene ontology and pathway enrichment, along with network topology and microarray meta-analysis, were used to generate hypothesis regarding dengue disease biology.</p> <p>Results</p> <p>Combining bioinformatic tools with two-hybrid technology, we screened human cDNA libraries to catalogue proteins physically interacting with the DENV2 virus structural proteins, Env, cap and PrM. We identified 31 interacting human proteins representing distinct biological processes that are closely related to the major clinical diagnostic feature of dengue infection: haemostatic imbalance. In addition, we found dengue-binding human proteins involved with additional key aspects, previously described as fundamental for virus entry into cells and the innate immune response to infection. Construction of a DENV2-human global protein interaction network revealed interesting biological properties suggested by simple network topology analysis.</p> <p>Conclusions</p> <p>Our experimental strategy revealed that dengue structural proteins interact with human protein targets involved in the maintenance of blood coagulation and innate anti-viral response processes, and predicts that the interaction of dengue proteins with a proposed human protein interaction network produces a modified biological outcome that may be behind the hallmark pathologies of dengue infection.</p

Power System Voltage Stability Margin Estimation Using Adaptive Neuro-Fuzzy Inference System Enhanced with Particle Swarm Optimization

In the current era of e-mobility and for the planning of sustainable grid infrastructures, developing new efficient tools for real-time grid performance monitoring is essential. Thus, this paper presents the prediction of the voltage stability margin (VSM) of power systems by the critical boundary index (CBI) approach using the machine learning technique. Prediction models are based on an adaptive neuro-fuzzy inference system (ANFIS) and its enhanced model with particle swarm optimization (PSO). Standalone ANFIS and PSO-ANFIS models are implemented using the fuzzy ‘c-means’ clustering method (FCM) to predict the expected values of CBI as a veritable tool for measuring the VSM of power systems under different loading conditions. Six vital power system parameters, including the transmission line and bus parameters, the power injection, and the system voltage derived from load flow analysis, are used as the ANFIS model implementation input. The performances of the two ANFIS models on the standard IEEE 30-bus and the Nigerian 28-bus systems are evaluated using error and regression analysis metrics. The performance metrics are the root mean square error (RMSE), mean absolute percentage error (MAPE), and Pearson correlation coefficient (R) analyses. For the IEEE 30-bus system, RMSE is estimated to be 0.5833 for standalone ANFIS and 0.1795 for PSO-ANFIS; MAPE is estimated to be 13.6002% for ANFIS and 5.5876% for PSO-ANFIS; and R is estimated to be 0.9518 and 0.9829 for ANFIS and PSO-ANFIS, respectively. For the NIGERIAN 28-bus system, the RMSE values for ANFIS and PSO-ANFIS are 5.5024 and 2.3247, respectively; MAPE is 19.9504% and 8.1705% for both ANFIS and PSO-ANFIS variants, respectively, and the R is estimated to be 0.9277 for ANFIS and 0.9519 for ANFIS-PSO, respectively. Thus, the PSO-ANFIS model shows a superior performance for both test cases, as indicated by the percentage reduction in prediction error, although at the cost of a higher simulation time

Vector capacity of members of Triatoma brasiliensis species complex: The need to extend Chagas disease surveillance to Triatoma melanica

Submitted by sandra infurna ([email protected]) on 2016-07-03T20:11:29Z No. of bitstreams: 1 carlos_almeida_etal_IOC_2016.pdf: 310645 bytes, checksum: ba89a5967da32fba1631a09db570cdab (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2016-07-03T20:29:21Z (GMT) No. of bitstreams: 1 carlos_almeida_etal_IOC_2016.pdf: 310645 bytes, checksum: ba89a5967da32fba1631a09db570cdab (MD5)Made available in DSpace on 2016-07-03T20:29:21Z (GMT). No. of bitstreams: 1 carlos_almeida_etal_IOC_2016.pdf: 310645 bytes, checksum: ba89a5967da32fba1631a09db570cdab (MD5) Previous issue date: 2016Submitted by Angelo Silva ([email protected]) on 2016-07-07T11:16:57Z No. of bitstreams: 3 carlos_almeida_etal_IOC_2016.pdf.txt: 33353 bytes, checksum: fb06d78000a9971855fb491ec56e0c7b (MD5) carlos_almeida_etal_IOC_2016.pdf: 310645 bytes, checksum: ba89a5967da32fba1631a09db570cdab (MD5) license.txt: 2991 bytes, checksum: 5a560609d32a3863062d77ff32785d58 (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2016-07-07T12:23:18Z (GMT) No. of bitstreams: 3 license.txt: 2991 bytes, checksum: 5a560609d32a3863062d77ff32785d58 (MD5) carlos_almeida_etal_IOC_2016.pdf: 310645 bytes, checksum: ba89a5967da32fba1631a09db570cdab (MD5) carlos_almeida_etal_IOC_2016.pdf.txt: 33353 bytes, checksum: fb06d78000a9971855fb491ec56e0c7b (MD5)Made available in DSpace on 2016-07-07T12:23:18Z (GMT). No. of bitstreams: 3 license.txt: 2991 bytes, checksum: 5a560609d32a3863062d77ff32785d58 (MD5) carlos_almeida_etal_IOC_2016.pdf: 310645 bytes, checksum: ba89a5967da32fba1631a09db570cdab (MD5) carlos_almeida_etal_IOC_2016.pdf.txt: 33353 bytes, checksum: fb06d78000a9971855fb491ec56e0c7b (MD5) Previous issue date: 2016Universidade Federal da Paraíba-UFPB. Programa de Pós-Graduação em Ecologia e Monitoramento Ambiental - PPGEMA. Laboratório Ecologia Animal. João Pessoa, PB, BrasilUniversity of Wisconsin-Platteville.Department of Geography and Geology. WI, USA.Centro Federal de Educação Tecnológica Celso Suckow da Fonseca - CEFET/RJ. Campus Valença. Valença, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Bioquímica de Interdisciplinar de Vigilância Entomológica em Diptera e Hemiptera. Rio de Janeiro, RJ, Brasil.Universidade Federal da Paraíba-UFPB. Programa de Pós-Graduação em Ecologia e Monitoramento Ambiental - PPGEMA. Laboratório Ecologia Animal. João Pessoa, PB, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biodiversidade Entomológica. Rio de Janeiro, RJ, Brasil.Universidade Federal da Paraíba-UFPB. Programa de Pós-Graduação em Ecologia e Monitoramento Ambiental - PPGEMA. João Pessoa, PB, Brasil.We conducted a lab-based comparative study on vector capacity features of two species of triatomines: Triatoma brasiliensis and T. melanica. Both are members of the T. brasiliensis species complex. The former is the most important Chagas disease vector in the northeastern region of Brazil. To date, no transmission via T. melanica has been recorded. Immature insects exhibited distinct intermoult periods without a direct relationship to a given species. Females of T. brasiliensis consumed an average of 1.9 times more meals (mean = 12.92 vs 6.63) and survived for a shorter period (mean =330.8 days) than T. melanica (mean = 365.2 days), probably due to the cost of reproduction (all significant at P39%) of insects defecated rapidly (<30 s) after feeding. Overall, results highlight the need to extend vector surveillance to T. melanica

A systematic review highlights the need to improve the quality and applicability of trials of physical therapy interventions for low back pain

Objective To review and assess the methodological quality of randomised controlled trials that test physical therapy interventions for low back pain. Study Design and Setting Systematic review of trials of physical therapy interventions to prevent or treat low back pain (of any duration or type) in participants of any age indexed on the Physiotherapy Evidence Database (PEDro). Existing PEDro scale ratings were used to evaluate methodology quality. Results This review identified 2215 trials. The majority of trials were for adults (n=2136, 96.4%), low back pain without specific aetiology (n=1863, 84.1%), and chronic duration (n=947, 42.8%). The quality of trials improved over time, however most were at risk of bias. Less than half of the trials concealed allocation to intervention (n=813, 36.7%), used intention-to-treat principles (n=778, 35.1%), blinded assessors (n=810, 36.6%), participants (n=174, 7.9%) and therapists (n=39, 1.8%). These findings did not vary by type of therapy. Conclusion The majority of trials that test physical therapy interventions for low back pain have methodological limitations that could bias treatment effect estimates. Greater attention to simple methodological features, such as allocation concealment and the reporting of intention-to-treat effects, would improve the quality of trials testing physical therapy interventions for low back pain.</p

Epidemiologie des accidents vasculaires cerebraux dans la commune de Lome (Togo) : Etude preliminaire.

Stroke is the third cause of death among hospitalized patients and the first aetiology of permanent physical disability throughout the world. They are public health problem not also in developed countriesbut also in developing ones. Aims of the study: The aim of this study was the feasibility and the installation of stroke register in orderto acquire a better understanding of particularities and epidemiology of this disease among our populations.Patients and method: A transversal and prospective study was employed to index epidemiology, clinic, paraclinic and evolutive data of patients hospitalized for stroke in 28 public and private health centres in Lome from July 15th to January 14th 2005.Results: 334 patients were hospitalized for stroke during the study period. This represented 2, 26 % of all hospitalized population. 99, 02% of these patients were in public hospitals. The incidence rate ofstroke was 79, 6 for 100.000 inhabitants. Patient’s age average was 59 years with a standard deviation (SD) of 13, 2. Average length time before admission in the health centre was 55 hours with 207, 5 SD.Average Rankin score scale at the admission was 3, 7 with 1, 1 SD. Average Rankin score scale at the release was 2, 3 with 0, 8 SD. 49, 7% of the patients had a cerebral CT scan done. 54, 8 % of stroke wasischemic; 45, 2% were haemorrhagic and 10, 8 % were meningeal bleeding. The main risk factors were high blood pressure (87, 3%), diabetes (17, 5%), hypercholesterolemia (4, 2%), irregular heart rate (4,2%). Hospital length stay average was 17 days with 8, 5 SD. Mortality rate was 27, 5%. This represented 7, 8% of all deaths registered during the study period

Combined Phylogenetic And Morphometric Information To Delimit And Unify The Triatoma Brasiliensis Species Complex And The Brasiliensis Subcomplex

“Triatoma brasiliensis species complex” was defined as a monophyletic group of the species: T. brasiliensis, T. juazeirensis, T. melanica, and T. sherlocki. An alternative grouping scheme proposed the concept of “Brasiliensis subcomplex” which included the former species together with T. melanocephala, T. petrocchiae, T. lenti, T. tibiamaculata, and T. vitticeps. To evaluate the relationship among these taxa we combined the results obtained with four mitochondrial genes (12S, 16S, COI and Cytb, adding to 1811 bp) and geometric morphometric analysis of wings and heads. Panstrongylus megistus was included in the analysis as it was previously found related to T. tibiamaculata, T. melanocephala and T. vitticeps. The results of both molecular and morphometric approaches clearly grouped the species analyzed into two monophyletic units, supported by both genetic and wing variability. The first one (G1) comprises the four species originally included in the T. brasiliensis species complex plus T. lenti and T. petrocchiae. The second group (G2) was composed by T. melanocephala, T. tibiamaculata and T. vitticeps, and remarkably, P. megistus if considering wing variability and phylogenetic results. Nevertheless, geometric morphometrics of heads provided a quantitative measurement that discriminates Panstrongylus from the Triatoma species based on the position of the antennal insertion relative to eyes, as it is used as the generic distinctive character. The discrepancy among approaches questions the validity of this character to define Panstrongylus genus. Independently of the chosen group definition —“T. brasiliensis species complex” or “Brasiliensis subcomplex”—we propose to delimit it to species of G1 that are all associated with the Caatinga biome in the Brazilian Northeast. G2 are the ones associated with the Atlantic Forest biome. © 2017 Elsevier B.V.17014014

Tantalum pentoxide micro-resonators for frequency comb generation

We present the design, fabrication, simulation and initial characterisation of tantalum pentoxide (Ta2O5) optical waveguides and micro-ring resonators for the purpose of supercontinuum and frequency comb generation. Spectral broadening results are presented for linear Ta2O5 waveguides for a range of central pump wavelengths between 900 nm and 1500 nm. These results are used as the basis for the dispersion engineering and development of Ta2O5 micro-ring resonators. The losses for sputtered and TEOS PECVD deposited SiO2 top cladded waveguides are characterised using a Fabry-Pérot loss measurement set-up. A solver based on the Lugiato-Lefever equation is presented and used to simulate the expected emission from the Ta2O5 micro-ring resonators. Promising initial experimental results show critical coupling and a Q-factor of 3.7×104