Which exercise for low back pain? (WELBack trial) Predicting response to exercise treatments for patients with low back pain : a validation randomized controlled trial protocol

Introduction Exercise therapy is the most recommended treatment for chronic low back pain (LBP). Effect sizes for exercises are usually small to moderate and could be due to the heterogeneity of people presenting with LBP. Thus, if patients could be better matched to exercise based on individual factors, then the effects of treatment could be greater. A recently published study provided evidence of better outcomes when patients are matched to the appropriate exercise type. The study demonstrated that a 15-item questionnaire, the Lumbar Spine Instability Questionnaire (LSIQ), could identify patients who responded best to one of the two exercise approaches for LBP (motor control and graded activity). The primary aim of the current study isill be to evaluate whether preidentified baseline characteristics, including the LSIQ, can modify the response to two of the most common exercise therapies for non-specific LBP. Secondary aims include an economic evaluations with a cost-effectiveness analysis. Methods and analysis Participants (n=414) will be recruited by primary care professionals and randomised (1:1) to receive motor control exercises or graded activity. Participants will undergo 12 sessions of exercise therapy over an 8-week period. The primary outcome will be physical function at 2 months using the Oswestry Disability Index. Secondary outcomes will be pain intensity, function and quality of life measured at 2, 6 and 12 months. Potential effect modifiers will be the LSIQ, self-efficacy, coping strategies, kinesiophobia and measures of nociceptive pain and central sensitisation. We will construct linear mixed models with terms for participants (fixed), treatment group, predictor (potential effect modifier), treatment group×predictor (potential effect modifier), physiotherapists, treatment group×physiotherapists and baseline score for the dependent variable

Pattern of activation of pelvic floor muscles in men differs with verbal instructions

AimsTo investigate the effect of instruction on activation of pelvic floor muscles (PFM) in men as quantified by transperineal ultrasound imaging (US) and to validate these measures with invasive EMG recordings

The timing of strike-slip shear along the Ranong and Khlong Marui faults, Thailand

The timing of shear along many important strike-slip faults in Southeast Asia, such as the Ailao Shan-Red River, Mae Ping and Three Pagodas faults, is poorly understood. We present 40Ar/39Ar, U-Pb SHRIMP and microstructural data from the Ranong and Khlong Marui faults of Thailand to show that they experienced a major period of ductile dextral shear during the middle Eocene (48–40 Ma, centered on 44 Ma) which followed two phases of dextral shear along the Ranong Fault, before the Late Cretaceous (>81 Ma) and between the late Paleocene and early Eocene (59–49 Ma). Many of the sheared rocks were part of a pre-kinematic crystalline basement complex, which partially melted and was intruded by Late Cretaceous (81–71 Ma) and early Eocene (48 Ma) tin-bearing granites. Middle Eocene dextral shear at temperatures of ~300–500°C formed extensive mylonite belts through these rocks and was synchronous with granitoid vein emplacement. Dextral shear along the Ranong and Khlong Marui faults occurred at the same time as sinistral shear along the Mae Ping and Three Pagodas faults of northern Thailand, a result of India-Burma coupling in advance of India-Asia collision. In the late Eocene (<37 Ma) the Ranong and Khlong Marui faults were reactivated as curved sinistral branches of the Mae Ping and Three Pagodas faults, which were accommodating lateral extrusion during India-Asia collision and Himalayan orogenesis

Remembering through lifelogging: A survey of human memory augmentation

Human memory is unquestionably a vital cognitive ability but one that can often be unreliable. External memory aids such as diaries, photos, alarms and calendars are often employed to assist in remembering important events in our past and future. The recent trend for lifelogging, continuously documenting ones life through wearable sensors and cameras, presents a clear opportunity to augment human memory beyond simple reminders and actually improve its capacity to remember. This article surveys work from the fields of computer science and psychology to understand the potential for such augmentation, the technologies necessary for realising this opportunity and to investigate what the possible benefits and ethical pitfalls of using such technology might be

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

A thermodynamic approach for assessing the environmental exposure of chemicals absorbed to microplastic

The environmental distribution and fate of microplastic in the marine environment represents a potential cause of concern. One aspect is the influence that microplastic may have on enhancing the transport and bioavailability of persistent, bioaccumulative, and toxic substances (PBT). In this study we assess these potential risks using a thermodynamic approach, aiming to prioritize the physicochemical properties of chemicals that are most likely absorbed by microplastic and therefore ingested by biota. Using a multimedia modeling approach, we define a chemical space aimed at improving our understanding of how chemicals partition in the marine environment with varying volume ratios of air/water/organic carbon/polyethylene, where polyethylene represents a main group of microplastic. Results suggest that chemicals with log KOW \u3e 5 have the potential to partition \u3e1% to polyethylene. Food-web model results suggest that reductions in body burden concentrations for nonpolar organic chemicals are likely to occur for chemicals with log KOW between 5.5 and 6.5. Thus the relative importance of microplastic as a vector of PBT substances to biological organisms is likely of limited importance, relative to other exposure pathways. Nevertheless, a number of data-gaps are identified, largely associated with improving our understanding of the physical fate of microplastic in the environment. © 2011 American Chemical Society

Comparison of dynamic features of pelvic floor muscle contraction between men with and without incontinence after prostatectomy and men with no history of prostate cancer

Aim: To compare features of pelvic floor muscle function between men with and without incontinence after prostatectomy and men with no history of prostate cancer. Methods: The study included men with incontinence postprostatectomy (PPI; n = 20), continent men postprostatectomy (PPC; n = 23) and a control group (CC; n = 20). Transperineal ultrasound imaging recorded motion associated with contraction of the striated urethral sphincter (SUS), puborectalis (PR) and bulbocavernosus (BC) muscles during maximal voluntary contraction (MVC), submaximal efforts, evoked coughing and bearing down. Anatomical landmark displacements were compared between groups and receiver operating characteristics were calculated to determine the threshold displacements that best differentiated PPI and PPC. Results: PPC demonstrated greater SUS, PR, and BC displacement than PPI during MVC (All: P

Validity of estimation of pelvic floor muscle activity from transperineal ultrasound imaging in men

Purpos