Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy

Contains fulltext : 47628.pdf (publisher's version ) (Closed access)BACKGROUND AND PURPOSE: An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. SUBJECTS: One hundred thirteen primary care physical therapists treated a total of 500 patients. METHODS: The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. RESULTS: Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. DISCUSSION AND CONCLUSION: The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved

Modelling the effect of aggregates on N2O emission from denitrification in an agricultural peat soil

Nitrous oxide (N2O) emissions are highly variable in time, with high peak emissions lasting a few days to several weeks and low background emissions. This temporal variability is poorly understood which hampers the simulation of daily N2O emissions. In structured soils, like clay and peat, aggregates hamper the diffusion of oxygen, which leads to anaerobic microsites in the soil, favourable for denitrification. Diffusion of N2O out of the aggregates is also hampered, which leads to delayed emissions and increased reduction of N2O to N-2. In this model simulation study we investigate the effect of aggregates in soils on the N2O emissions. We present a parameterization to simulate the effects of aggregates on N2O production by denitrification and on N2O reduction. The parameterization is based on the mobile-immobile model concept. It was implemented in a field-scale hydrological-biogeochemical model combination. We compared the simulated fluxes with observed fluxes from a fertilized and drained peat soil under grass. The results of this study show that aggregates strongly affect the simulated N2O emissions: peak emissions are lower, whereas the background emissions are slightly higher. Including the effect of aggregates caused a 40% decrease in the simulated annual emissions relative to the simulations without accounting for the effects of aggregates. The new parameterization significantly improved the model performance regarding simulation of observed daily N2O fluxes; r(2) and RMSE improved from 0.11 and 198 g N2O-N ha(-1) d(-1) to 0.41 and 40 g N2O-N ha(-1) d(-1), respectively. Our analyses of the model results show that aggregates have a larger impact on the reduction than on the production of N2O. Reduction of N2O is more sensitive to changes in the drivers than production of N2O and is in that sense the key to understanding N2O emissions from denitrification. The effects of changing environmental conditions on reduction of N2O relative to N2O production strongly depend on the NO3 content of the soil. More anaerobic conditions have hardly any effect on the ratio of production to reduction if NO3 is abundant, but will decrease this ratio if NO3 is limiting. In the first case the emissions will increase, whereas in the second case the emissions will decrease. This study suggests that the current knowledge of the hydrological, biogeochemical and physical processes may be sufficient to understand the observed N2O fluxes from a fertilized clayey peatland. Further research is needed to test how aggregates affect the N2O fluxes from other soils or soils with different fertilization regimes

Peripheral Blood Immune Cell Composition After Autologous MSC Infusion in Kidney Transplantation Recipients

Tacrolimus is the backbone of immunosuppressive agents to prevent transplant rejection. Paradoxically, tacrolimus is nephrotoxic, causing irreversible tubulointerstitial damage. Therefore, infusion of mesenchymal stromal cells (MSC) 6 and 7 weeks post-transplantation was assessed to facilitate withdrawal of tacrolimus in the randomized phase II TRITON trial. Here, we performed detailed analysis of the peripheral blood immune composition using mass cytometry to assess potential effects of MSC therapy on the immune system. We developed two metal-conjugated antibody panels containing 40 antibodies each. PBMC samples from 21 MSC-treated patients and 13 controls, obtained pre-transplant and at 24 and 52 weeks post-transplantation, were analyzed. In the MSC group at 24 weeks, 17 CD4+ T cell clusters were increased of which 14 Th2-like clusters and three Th1/Th2-like clusters, as well as CD4+FoxP3+ Tregs. Additionally, five B cell clusters were increased, representing either class switched memory B cells or proliferating B cells. At 52 weeks, CCR7+CD38+ mature B cells were decreased. Finally, eight Tc1 (effector) memory cytotoxic T cell clusters were increased. Our work provides a comprehensive account of the peripheral blood immune cell composition in kidney transplant recipients after MSC therapy and tacrolimus withdrawal. These results may help improving therapeutic strategies using MSCs with the aim to reduce the use of calcineurin inhibitors. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02057965.</p

General relativistic Sagnac formula revised

The Sagnac effect is a time or phase shift observed between two beams of light traveling in opposite directions in a rotating interferometer. We show that the standard description of this effect within the framework of general relativity misses the effect of deflection of light due to rotational inertial forces. We derive the necessary modification and demonstrate it through a detailed analysis of the square Sagnac interferometer rotating about its symmetry axis in Minkowski space-time. The role of the time shift in a Sagnac interferometer in the synchronization procedure of remote clocks as well as its analogy with the Aharanov-Bohm effect are revised.Comment: 11 pages, 3 figure

Kijk op Multifunctionele landbouw; OMZET en IMPACT 2007-2011

De multifunctionele landbouw in Nederland is ook de laatste jaren een groeiende sector. Dit blijkt uit de 2-meting die volgde op de 1-meting van 2 jaar geleden. De omzet in de multifunctionele landbouw is tussen 2007 en 2011 met 52 procent toegenomen tot 491 miljoen euro. De impact van multifunctionele bedrijven gaat verder dan de inkomsten voor de betreffende bedrijven alleen. Zo werken er gemiddeld meer mensen op een multifunctioneel dan op een regulier bedrijf

Kijk op multifunctionele landbouw, omzet en impact 2007-2009

De multifunctionele landbouw in Nederland zit in de lift. Dit blijkt uit de eenmeting van Wageningen UR naar de omzet en impact van multifunctionele landbouw. Deze eenmeting over 2009 volgt op de nulmeting die plaatsvond over de cijfers uit 2007. De totale omzet uit zorgboerderijen, agrarische kinderopvang, boerderijverkoop, agrarisch natuur- beheer, recreatie & toerisme en boerderijeducatie steeg met naar schatting 28% in de periode 2007-2009. De sector agrarisch natuurbeheer werd als enige sector geconfronteerd met een omzetdaling door minder subsidieontvangsten

Search for displaced vertices arising from decays of new heavy particles in 7 TeV pp collisions at ATLAS

We present the results of a search for new, heavy particles that decay at a significant distance from their production point into a final state containing charged hadrons in association with a high-momentum muon. The search is conducted in a pp-collision data sample with a center-of-mass energy of 7 TeV and an integrated luminosity of 33 pb^-1 collected in 2010 by the ATLAS detector operating at the Large Hadron Collider. Production of such particles is expected in various scenarios of physics beyond the standard model. We observe no signal and place limits on the production cross-section of supersymmetric particles in an R-parity-violating scenario as a function of the neutralino lifetime. Limits are presented for different squark and neutralino masses, enabling extension of the limits to a variety of other models.Comment: 8 pages plus author list (20 pages total), 8 figures, 1 table, final version to appear in Physics Letters