Digital support interventions for the self-management of low back pain: a systematic review

Background: Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health. Objective: The study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes? Methods: Bibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively. Results: Of the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm. Conclusions: The literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digital interventions to support patient self-management of LBP remains weak

The use of internet analytics by a Canadian provincial chiropractic regulator to monitor, evaluate and remediate misleading claims regarding specific health conditions, pregnancy, and COVID-19

Background Internet analytics are increasingly being integrated into public health regulation. One specific application is to monitor compliance of website and social media activity with respect to jurisdictional regulations. These data may then identify breaches of compliance and inform disciplinary actions. Our study aimed to evaluate the novel use of internet analytics by a Canadian chiropractic regulator to determine their registrants compliance with three regulations related to specific health conditions, pregnancy conditions and most recently, claims of improved immunity during the COVID-19 crisis. Methods A customized internet search tool (Market Review Tool, MRT) was used by the College of Chiropractors of British Columbia (CCBC), Canada to audit registrants websites and social media activity. The audits extracted words whose use within specific contexts is not permitted under CCBC guidelines. The MRT was first used in October of 2018 to identify words related to specific health conditions. The MRT was again used in December 2019 for words related to pregnancy and most recently in March 2020 for words related to COVID-19. In these three MRT applications, potential cases of word misuse were evaluated by the regulator who then notified the practitioner to comply with existing regulations by a specific date. The MRT was then used on that date to determine compliance. Those found to be non-compliant were referred to the regulator’s inquiry committee. We mapped this process and reported the outcomes with permission of the regulator. Results In September 2018, 250 inappropriate mentions of specific health conditions were detected from approximately 1250 registrants with 2 failing to comply. The second scan for pregnancy related terms of approximately1350 practitioners revealed 83 inappropriate mentions. Following notification, all 83 cases were compliant within the specified timeframe. Regarding COVID-19 related words, 97 inappropriate mentions of the word “immune” were detected from 1350 registrants with 7 cases of non-compliance. Conclusion Internet analytics are an effective way for regulators to monitor internet activity to protect the public from misleading statements. The processes described were effective at bringing about rapid practitioner compliance. Given the increasing volume of internet activity by healthcare professionals, internet analytics are an important addition for health care regulators to protect the public they serve

Chiropractic, one big unhappy family: Better together or apart?

Background The chiropractic profession has a long history of internal conflict. Today, the division is between the 'evidence-friendly' faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the 'traditional' group that subscribes to concepts such as 'subluxation' and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care. Because this is an issue with many factors to consider, we decided to illustrate it with an analogy. We aimed to examine the chiropractic profession from the perspective of an unhappy marriage by defining key elements in happy and unhappy marriages and by identifying factors that may determine why couples stay together or spilt up. Main body We argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect. We also contend that the profession could be conceptualised as existing on a spectrum with the 'evidence-friendly' and the 'traditional' groups inhabiting the end points, with the majority of chiropractors in the middle. This middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of 'you never know who and what will respond to spinal manipulation'. We believe that this 'silent majority' makes it possible for groups of chiropractors to practice outside the logical framework of today's scientific concepts. Conclusion There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions. This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up

Carbon Neutral Production Of Syngas Via High Temperature Electrolytic Reduction Of Steam And CO2

This paper presents the most recent results of experiments conducted at the Idaho National Laboratory (INL) studying coelectrolysis of steam and carbon dioxide in solid-oxide electrolysis stacks. Two 10-cell planar stacks were tested under various gas compositions, operating voltages, and operating temperatures. The tests were heavily instrumented, and outlet gas compositions were monitored with a gas chromatograph. Measured outlet compositions, open cell potentials, and coelectrolysis thermal neutral voltages compared reasonably well with a coelectrolysis computer model developed at the INL. Stack ASRs did not change significantly when switching from electrolysis to coelectrolysis operation

Recent Progress At The Idaho National Laboratory In High Temperature Electrolysis For Hydrogen And Syngas Production

This paper presents the most recent results of experiments conducted at the Idaho National Laboratory (INL) studying electrolysis of steam and coelectrolysis of steam / carbon dioxide in solid-oxide electrolysis stacks. Single button cell tests as well as multi-cell stack testing have been conducted. Multi-cell stack testing used 10 x 10 cm cells (8 x 8 cm active area) supplied by Ceramatec, Inc (Salt Lake City, Utah, USA) and ranged from 10 cell short stacks to 240 cell modules. Tests were conducted either in a bench-scale test apparatus or in a newly developed 5 kW Integrated Laboratory Scale (ILS) test facility. Gas composition, operating voltage, and operating temperature were varied during testing. The tests were heavily instrumented, and outlet gas compositions were monitored with a gas chromatograph. The ILS facility is currently being expanded to 15 kW testing capacity (H2 production rate based upon lower heating value)

TEST RESULTS OF HIGH TEMPERATURE STEAM/CO2 CO-ELECTROLYSIS IN A 10-CELL STACK

High temperature coelectrolysis experiments with CO2 / H2O mixtures were performed in a 10-cell planar solid oxide stack. Results indicated that stack apparent ASR values were shown not to vary significantly between pure steam electrolysis and steam / CO2 coelectrolysis values. Product gas compositions measured via an online micro gas chromatograph (GC) showed excellent agreement to predictions obtained from a chemical equilibrium coelectrolysis model developed for this study. Experimentally determined open cell potentials and thermal neutral voltages for coelectrolysis compared favorably to predictions obtained from a chemical equilibrium coelectrolysis and energy balance model, also developed for this study

Characteristics of chiropractors who manage people aged 65 and older: A nationally representative sample of 1903 chiropractors

© 2019 AJA Inc. Objective: To examine the prevalence and profile of chiropractors who frequently manage people aged 65 years and older. Methods: A national cross-sectional survey collected practitioner characteristics, practice settings and clinical management characteristics. Multiple logistic regression was conducted on 1903 chiropractors to determine the factors associated with the frequent treatment of people 65 years and older. Results: In total, 73.5% of participants report “often” treating those aged 65 years and older. These chiropractors were associated with treating degenerative spine conditions (OR [odds ratio] 2.25; 95% [confidence interval] CI 1.72-2.94), working in a non-urban area (OR 1.85; 95% CI 1.35-2.54), treating low back pain (referred/radicular) (OR 1.74; 95% CI 1.26-2.40) and lower limb musculoskeletal disorders (OR 1.50; 95% CI 1.15-1.96). Conclusions: The majority of chiropractors report often providing treatment to older people. Our findings call for more research to better understand older patient complaints that are common to chiropractic practice and the care provided by chiropractors for this patient group

Thermal and Electrochemical Performance of a High-Temperature Steam Electrolysis Stack

A research program is under way at the Idaho National Laboratory (INL) to simultaneously address the research and scale-up issues associated with the implementation of solid-oxide electrolysis cell technology for hydrogen production from steam. We are conducting a progression of electrolysis stack testing activities, at increasing scales, along with a continuation of supporting research activities in the areas of materials development, single-cell testing, detailed computational fluid dynamics (CFD) and systems modeling. This paper will present recent experimental results obtained from testing of planar solid-oxide stacks operating in the electrolysis mode. The hydrogen-production and electrochemical performance of these stacks will be presented, over a range of operating conditions. In addition, internal stack temperature measurements will be presented, with comparisons to computational fluid dynamic predictions

On the number of kk-cycles in the assignment problem for random matrices

We continue the study of the assignment problem for a random cost matrix. We analyse the number of $k$-cycles for the solution and their dependence on the symmetry of the random matrix. We observe that for a symmetric matrix one and two-cycles are dominant in the optimal solution. In the antisymmetric case the situation is the opposite and the one and two-cycles are suppressed. We solve the model for a pure random matrix (without correlations between its entries) and give analytic arguments to explain the numerical results in the symmetric and antisymmetric case. We show that the results can be explained to great accuracy by a simple ansatz that connects the expected number of $k$-cycles to that of one and two cycles.Comment: To appear in Journal of Statistical Mechanic