The green bullwhip effect: Transferring environmental requirements along a supply chain

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Total knee arthroplasty after high tibial osteotomy. A systematic review

Background: Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee arthroplasty. Methods: A computerized search for relevant studies published up to September 2007 was performed in Medline and Embase using a search strategy that is highly sensitive to find nonrandomized studies. Included were observational studies in which patients had total knee arthroplasty performed after prior high tibial osteotomy. Studies that fulfilled these criteria, were assessed for methodologic quality by two independent reviewers using the critical appraisal of observational studies developed by Deeks and the MINORS instrument. The study characteristics and data on the intervention, follow-up, and outcome measures, were extracted using a pre-tested standardized form. Primary outcomes were: knee range of motion, knee clinical score, and revision surgery. The grade of evidence was determined using the guidelines of the GRADE working group. Results: Of the 458 articles identified using our search strategy, 17 met the inclusion criteria. Fifteen studies were cohort study with a concurrent control group, one was a historical cohort study and one a case-control study. Nine studies scored 50% or more on both methodological quality assessments. Pooling of the results was not possible due to the heterogeneity of the studies, and our analysis could not raise the overall low quality of evidence. No significant differences between primary total knee arthroplasty and total knee arthroplasty after osteotomy were found for knee range of motion in four out of six studies, knee clinical scores in eight out of nine studies, and revision surgery in eight out of eight studies after a median follow-up of 5 years. Conclusion: Our analysis suggests that osteotomy does not compromise subsequent knee replacement. However, the low quality of evidence precludes solid clinical conclusions.</p

Total knee arthroplasty after high tibial osteotomy. A systematic review

Background: Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee arthroplasty. Methods: A computerized search for relevant studies published up to September 2007 was performed in Medline and Embase using a search strategy that is highly sensitive to find nonrandomized studies. Included were observational studies in which patients had total knee arthroplasty performed after prior high tibial osteotomy. Studies that fulfilled these criteria, were assessed for methodologic quality by two independent reviewers using the critical appraisal of observational studies developed by Deeks and the MINORS instrument. The study characteristics and data on the intervention, follow-up, and outcome measures, were extracted using a pre-tested standardized form. Primary outcomes were: knee range of motion, knee clinical score, and revision surgery. The grade of evidence was determined using the guidelines of the GRADE working group. Results: Of the 458 articles identified using our search strategy, 17 met the inclusion criteria. Fifteen studies were cohort study with a concurrent control group, one was a historical cohort study and one a case-control study. Nine studies scored 50% or more on both methodological quality assessments. Pooling of the results was not possible due to the heterogeneity of the studies, and our analysis could not raise the overall low quality of evidence. No significant differences between primary total knee arthroplasty and total knee arthroplasty after osteotomy were found for knee range of motion in four out of six studies, knee clinical scores in eight out of nine studies, and revision surgery in eight out of eight studies after a median follow-up of 5 years. Conclusion: Our analysis suggests that osteotomy does not compromise subsequent knee replacement. However, the low quality of evidence precludes solid clinical conclusions.</p

Ruling out Stellar Companions and Resolving the Innermost Regions of Transitional Disks with the Keck Interferometer

With the Keck Interferometer, we have studied at 2 um the innermost regions of several nearby, young, dust depleted "transitional" disks. Our observations target five of the six clearest cases of transitional disks in the Taurus/Auriga star-forming region (DM Tau, GM Aur, LkCa 15, UX Tau A, and RY Tau) to explore the possibility that the depletion of optically thick dust from the inner disks is caused by stellar companions rather than the more typical planet-formation hypothesis. At the 99.7% confidence level, the observed visibilities exclude binaries with flux ratios of at least 0.05 and separations ranging from 2.5 to 30 mas (0.35 - 4 AU) over >= 94% of the area covered by our measurements. All targets but DM Tau show near-infrared excess in their SED higher than our companion flux ratio detection limits. While a companion has previously been detected in the candidate transitional disk system CoKu Tau/4, we can exclude similar mass companions as the typical origin for the clearing of inner dust in transitional disks and of the near-infrared excess emission. Unlike CoKu Tau/4, all our targets show some evidence of accretion. We find that all but one of the targets are clearly spatially resolved, and UX Tau A is marginally resolved. Our data is consistent with hot material on small scales (0.1 AU) inside of and separated from the cooler outer disk, consistent with the recent SED modeling. These observations support the notion that some transitional disks have radial gaps in their optically thick material, which could be an indication for planet formation in the habitable zone (~ a few AU) of a protoplanetary disk.Comment: 36 pages, 7 figures. Accepted for publication in Ap

Predicting Time on Prolonged Benefits for Injured Workers with Acute Back Pain

Introduction Some workers with work-related compensated back pain (BP) experience a troubling course of disability. Factors associated with delayed recovery among workers with work-related compensated BP were explored. Methods This is a cohort study of workers with compensated BP in 2005 in Ontario, Canada. Follow up was 2æyears. Data was collected from employers, employees and health-care providers by the Workplace Safety and Insurance Board (WSIB). Exclusion criteria were: (1) no-lost-time claims, (2) \u3e30ædays between injury and claim filing, (3) 65æyears. Using proportional hazard models, we examined the prognostic value of information collected in the first 4æweeks after injury. Outcome measures were time on benefits during the first episode and time until recurrence after the first episode. Results Of 6,657 workers, 1,442 were still on full benefits after 4æweeks. Our final model containing age, physical demands, opioid prescription, union membership, availability of a return-to-work program, employer doubt about work-relatedness of injury, worker?s recovery expectations, participation in a rehabilitation program and communication of functional ability was able to identify prolonged claims to a fair degree [area under the curve (AUC)æ=æ.79, 95æ% confidence interval (CI) .74?.84]. A model containing age, sex, physical demands, opioid prescription and communication of functional ability was less successful at predicting time until recurrence (AUCæ=æ.61, 95æ% CI .57, .65). Conclusions Factors contained in information currently collected by the WSIB during the first 4æweeks on benefits can predict prolonged claims, but not recurrent claims. Electronic supplementary material The online version of this article (doi:10.1007/s10926-014-9534-5) contains supplementary material, which is available to authorized users

A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments

Anomalous Couplings in Double Higgs Production

The process of gluon-initiated double Higgs production is sensitive to non-linear interactions of the Higgs boson. In the context of the Standard Model, studies of this process focused on the extraction of the Higgs trilinear coupling. In a general parametrization of New Physics effects, however, an even more interesting interaction that can be tested through this channel is the (ttbar hh) coupling. This interaction vanishes in the Standard Model and is a genuine signature of theories in which the Higgs boson emerges from a strongly-interacting sector. In this paper we perform a model-independent estimate of the LHC potential to detect anomalous Higgs couplings in gluon-fusion double Higgs production. We find that while the sensitivity to the trilinear is poor, the perspectives of measuring the new (ttbar hh) coupling are rather promising.Comment: 22 pages, 9 figures. v2: plots of Figs.8 and 9 redone to include experimental uncertainty on the Higgs couplings, references adde

Reducing Opioid Use for Chronic Pain With a Group-Based Intervention: A Randomized Clinical Trial

IMPORTANCE: Opioid use for chronic nonmalignant pain can be harmful. OBJECTIVE: To test whether a multicomponent, group-based, self-management intervention reduced opioid use and improved pain-related disability compared with usual care. DESIGN, SETTING, AND PARTICIPANTS: Multicentered, randomized clinical trial of 608 adults taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) to treat chronic nonmalignant pain. The study was conducted in 191 primary care centers in England between May 17, 2017, and January 30, 2019. Final follow-up occurred March 18, 2020. INTERVENTION: Participants were randomized 1:1 to either usual care or 3-day-long group sessions that emphasized skill-based learning and education, supplemented by 1-on-1 support delivered by a nurse and lay person for 12 months. MAIN OUTCOMES AND MEASURES: The 2 primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7-77; 77 indicates worst pain interference; minimal clinically important difference, 3.5) and the proportion of participants who discontinued opioids at 12 months, measured by self-report. RESULTS: Of 608 participants randomized (mean age, 61 years; 362 female [60%]; median daily morphine equivalent dose, 46 mg [IQR, 25 to 79]), 440 (72%) completed 12-month follow-up. There was no statistically significant difference in PROMIS-PI-SF-8a scores between the 2 groups at 12-month follow-up (-4.1 in the intervention and -3.17 in the usual care groups; between-group difference: mean difference, -0.52 [95% CI, -1.94 to 0.89]; P = .15). At 12 months, opioid discontinuation occurred in 65 of 225 participants (29%) in the intervention group and 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% CI, 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P < .001). Serious adverse events occurred in 8% (25/305) of the participants in the intervention group and 5% (16/303) of the participants in the usual care group. The most common serious adverse events were gastrointestinal (2% in the intervention group and 0% in the usual care group) and locomotor/musculoskeletal (2% in the intervention group and 1% in the usual care group). Four people (1%) in the intervention group received additional medical care for possible or probable symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt). CONCLUSIONS AND RELEVANCE: In people with chronic pain due to nonmalignant causes, compared with usual care, a group-based educational intervention that included group and individual support and skill-based learning significantly reduced patient-reported use of opioids, but had no effect on perceived pain interference with daily life activities. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN49470934

A survey of training and practice patterns of massage therapists in two US states

BACKGROUND: Despite the growing popularity of therapeutic massage in the US, little is known about the training or practice characteristics of massage therapists. The objective of this study was to describe these characteristics. METHODS: As part of a study of random samples of complementary and alternative medicine (CAM) practitioners, we interviewed 226 massage therapists licensed in Connecticut and Washington state by telephone in 1998 and 1999 (85% of those contacted) and then asked a sample of them to record information on 20 consecutive visits to their practices (total of 2005 consecutive visits). RESULTS: Most massage therapists were women (85%), white (95%), and had completed some continuing education training (79% in Connecticut and 52% in Washington). They treated a limited number of conditions, most commonly musculoskeletal (59% and 63%) (especially back, neck, and shoulder problems), wellness care (20% and 19%), and psychological complaints (9% and 6%) (especially anxiety and depression). Practitioners commonly used one or more assessment techniques (67% and 74%) and gave a massage emphasizing Swedish (81% and 77%), deep tissue (63% and 65%), and trigger/pressure point techniques (52% and 46%). Self-care recommendations, including increasing water intake, body awareness, and specific forms of movement, were made as part of more than 80% of visits. Although most patients self-referred to massage, more than one-quarter were receiving concomitant care for the same problem from a physician. Massage therapists rarely communicated with these physicians. CONCLUSION: This study provides new information about licensed massage therapists that should be useful to physicians and other healthcare providers interested in learning about massage therapy in order to advise their patients about this popular CAM therapy