Patellofemoral pain: challenging current practice – a case report

Patellofemoral pain (PFP) is a common problem in young people, with 1 in 6 suffering at any one time. It is unclear which management approach is the optimal method for treating PFP in the long term, with traditional physiotherapy examination focusing on assessing for specific structural dysfunction. A rationale for a different assessment and treatment approach, one that moves the focus away from a biomedical/tissue pathology model towards one directed at the neurophysiology of pain, has been suggested. The patient was a 21 year old male with a 6 year history of PFP with previous failed physiotherapeutic treatment. He reported previous multiple healthcare practitioners' advice to avoid activities that were painful as reasons for being unable to participate in sporting activities. No specific structural testing was performed, such as specific muscle strength, length, foot position, patella movement and position, or movement patterns. Descriptions of tissue based pathology models of pain, e.g. patella mal-tracking, were actively discouraged and challenged. The patient was taught to perform one uncomfortable/painful exercise as part of his rehabilitation programme twice a day. The patient achieved 80% improvement in his symptoms over 7 appointments and a return to physical activity following a 5 month rehabilitation programme purposively designed to elicit pain by means of gradually exercising and loading the tissues. This case report highlights the need for further research into exercise protocols for patients suffering with PFP based upon neurophysiology models of pain

UV frequency metrology on CO (a3Pi); isotope effects and sensitivity to a variation of the proton-to-electron mass ratio

UV frequency metrology has been performed on the a3Pi - X1Sigma+ (0,0) band of various isotopologues of CO using a frequency-quadrupled injection-seeded narrow-band pulsed Titanium:Sapphire laser referenced to a frequency comb laser. The band origin is determined with an accuracy of 5 MHz (delta \nu / \nu = 3 * 10^-9), while the energy differences between rotational levels in the a3Pi state are determined with an accuracy of 500 kHz. From these measurements, in combination with previously published radiofrequency and microwave data, a new set of molecular constants is obtained that describes the level structure of the a3Pi state of 12C16O and 13C16O with improved accuracy. Transitions in the different isotopologues are well reproduced by scaling the molecular constants of 12C16O via the common mass-scaling rules. Only the value of the band origin could not be scaled, indicative of a breakdown of the Born-Oppenheimer approximation. Our analysis confirms the extreme sensitivity of two-photon microwave transitions between nearly-degenerate rotational levels of different Omega-manifolds for probing a possible variation of the proton-to-electron mass ratio, \mu=m_p/m_e, on a laboratory time scale

The Politics of the 1965 Gold Reserve Law

The major focus of this study is the 1965 gold reserve law. Thislaw was both an economic and political solution to a number of problemswhich are discussed under the general subject of the United States balanceof payments. I have used the 1965 law to illustrate many processes withinthe American political system

(1R,3S)-N-Benzhydryl-2-benzyl-6,7-dimeth­oxy-1-phenyl-1,2,3,4-tetra­hydro­isoquinoline-3-carbothio­amide

The title compound, C38H36N2O2S, has a heterocyclic ring that assumes a half-chair conformation. The phenyl rings of neighbouring mol­ecules align forming alternating chains parallel to [100] within the crystal packing. The absolute stereochemistry of the crystal was confirmed to be R,S at the 1- and 3-positions, respectively, by proton NMR spectroscopy. A single intra­molecular N—H⋯N hydrogen bond is observed

Social Network and Content Analysis of the North American Carbon Program as a Scientific Community of Practice

The North American Carbon Program (NACP) was formed to further the scientific understanding of sources, sinks, and stocks of carbon in Earth's environment. Carbon cycle science integrates multidisciplinary research, providing decision-support information for managing climate and carbon-related change across multiple sectors of society. This investigation uses the conceptual framework of com-munities of practice (CoP) to explore the role that the NACP has played in connecting researchers into a carbon cycle knowledge network, and in enabling them to conduct physical science that includes ideas from social science. A CoP describes the communities formed when people consistently engage in shared communication and activities toward a common passion or learning goal. We apply the CoP model by using keyword analysis of abstracts from scientific publications to analyze the research outputs of the NACP in terms of its knowledge domain. We also construct a co-authorship network from the publications of core NACP members, describe the structure and social pathways within the community. Results of the content analysis indicate that the NACP community of practice has substantially expanded its research on human and social impacts on the carbon cycle, contributing to a better understanding of how human and physical processes interact with one another. Results of the co-authorship social network analysis demonstrate that the NACP has formed a tightly connected community with many social pathways through which knowledge may flow, and that it has also expanded its network of institutions involved in carbon cycle research over the past seven years

Typing Supernova Remnants Using X-ray Line Emission Morphologies

We present a new observational method to type the explosions of young supernova remnants (SNRs). By measuring the morphology of the Chandra X-ray line emission in seventeen Galactic and Large Magellanic Cloud SNRs with a multipole expansion analysis (using power ratios), we find that the core-collapse SNRs are statistically more asymmetric than the Type Ia SNRs. We show that the two classes of supernovae can be separated naturally using this technique because X-ray line morphologies reflect the distinct explosion mechanisms and structure of the circumstellar material. These findings are consistent with recent spectropolarimetry results showing that core-collapse SNe are intrinsically more asymmetric.Comment: 4 pages, 1 figure, accepted for publication in ApJ

Pauli blocking of stimulated emission in a degenerate Fermi gas

The Pauli exclusion principle in quantum mechanics has a profound influence on the structure of matter and on interactions between fermions. Almost 30 years ago it was predicted that the Pauli exclusion principle could lead to a suppression of spontaneous emission, and only recently several experiments confirmed this phenomenon. Here we report that this so-called Pauli blockade not only affects incoherent processes but also, more generally, coherently driven systems. It manifests itself as an intriguing sub-Doppler narrowing of a doubly-forbidden transition profile in an optically trapped Fermi gas of $^3\mathrm{He}$. By actively pumping atoms out of the excited state, we break the coherence of the excitation and lift the narrowing effect, confirming the influence of Pauli blockade on the transition profile. This new insight into the interplay between quantum statistics and coherent driving is a promising development for future applications involving fermionic systems.Comment: 36 pages, 8 figure

Effects of transportation, handling and environment on slaughter cattle. I, Weight loss and carcass yield

Includes bibliographical references (page 11)

Should exercises be painful in the management of chronic musculoskeletal pain?: a systematic review and meta-analysis

Background: Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient’s pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged, compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials. Methods: Two authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool and the GRADE system was used to evaluate the quality of evidence. Results: The literature search identified 9,081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short term significant difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. For pain at medium and long term; and function and disability at short, medium and long term there was no significant difference. Conclusion: Protocols using painful exercises offer a small, but significant benefit over pain-free exercises at short term, with moderate quality of the evidence. At medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders. PROSPERO Registration: CRD4201603888

The experience of living with patellofemoral pain: loss, confusion and fear-avoidance: a UK qualitative study

Objectives: To investigate the experience of living with patellofemoral pain. Design: Qualitative study design using semi-structured interviews, and analysed thematically using the guidelines set out by Braun and Clarke. Setting: A National Health Service (NHS) physiotherapy clinic within a large UK teaching hospital. Participants: A convenience sample of ten participants, aged between 18 and 40, with a diagnosis of patellofemoral pain and on a physiotherapy waiting list, prior to starting physiotherapy. Results: Participants offered rich and detailed accounts of the impact and lived experience of patellofemoral pain, including: loss of physical and functional ability; loss of self - identity; pain related confusion and difficulty making sense of their pain ; pain related fear, including fear -avoidance and ‘damage’ beliefs; inappropriate coping strategies and fear of the future. The five major themes that emerged from the data were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future. Conclusions: These findings offer an insight into the lived experience of individuals with patellofemoral pain. Previous literature ha s focused on pain and biomechanics, rather than the individual experience, attached meanings and any wider context within a sociocultural perspective. Our findings suggest future research is warranted into biopsychosocial targeted interventions aimed at the beliefs and pain related fear for people with patellofemoral pain. The current consensus that best - evidence treatments consisting of hip and knee strengthening may not be adequate to address the fears and beliefs identified in the current study. Further qualitative research may be warranted on the impact and interpretation of medical terminology commonly used with this patient group, for example, ‘weakness’ and ‘patellar mal-tracking’ and its impact and interpretation by patients