Maintenance care in chiropractic – what do we know?

<p>Abstract</p> <p>Background</p> <p>Back problems are often recurring or chronic. It is therefore not surprising that chiropractors wish to prevent their return or reduce their impact. This is often attempted with a long-term treatment strategy, commonly called maintenance care. However, some aspects of maintenance care are considered controversial. It is therefore relevant to investigate the scientific evidence forming the basis for its use.</p> <p>Objectives</p> <p>A review of the literature was performed in order to obtain answers to the following questions: What is the exact definition of maintenance care, what are its indications for use, and how is it practised? How common is it that chiropractors support the concept of maintenance care, and how well accepted is it by patients? How frequently is maintenance care used, and what factors are associated with its use? Is maintenance care a clinically valid method of approach, and is it cost-effective for the patient?</p> <p>Results</p> <p>Thirteen original studies were found, in which maintenance care was investigated. The relative paucity of studies, the obvious bias in many of these, the lack of exhaustive information, and the diversity of findings made it impossible to answer any of the questions.</p> <p>Conclusion</p> <p>There is no evidence-based definition of maintenance care and the indications for and nature of its use remains to be clearly stated. It is likely that many chiropractors believe in the usefulness of maintenance care but it seems to be less well accepted by their patients. The prevalence with which maintenance care is used has not been established. Efficacy and cost-effectiveness of maintenance care for various types of conditions are unknown. Therefore, our conclusion is identical to that of a similar review published in 1996, namely that maintenance care is not well researched and that it needs to be investigated from several angles before the method is subjected to a multi-centre trial.</p

Et kig på socialsemiotikken fra Dansk Sprognævn

In this paper, I hint at some possible affinities between social semiotics as a descriptive practice of investigating language as well as a plethora of modalities in communication, and the normative work carried out by The Danish Language Council (Dansk Sprognævn). First, one could envisage how the social semiotic approach to multimodality could function in research on ‘domain loss’: this is research which traditionally focuses on the use of one language over another in specific domains of life, but it could be expanded to include the use of one modality (e.g. photographs) over another (e.g. language). Second, in The Danish Language Council, research is carried out on how we communicate in various digitalized media, e.g. on Instagram and Snapchat, and here again an understanding of multimodal social semiotics could enlighten research on e.g. emojis (which are often used instead of standard punctuation). Finally, the understanding of genres in social semiotics bears some affinities to work done on clear communication (‘klarsprog’). Despite these affinities, the paper does not suggest that the more descriptive practice of social semiotics and the primarily normative and corpus based foundations of the research done in The Danish Language Council (e.g. when working with the standardization of the orthography of Danish), in general, are compatible

Carbonaceous materials for the electrochemical clean-up of wastewater

Using carbon adsorbents is the most common method of removing waste organics from water. However, the question remains of what to do with the carbon after adsorption. Landfill or incineration come with the obvious environmental consequences, and thermal regeneration is energetically costly and can be wasteful. The wastewater management company Arvia have developed a process for using electrochemical regeneration as an alternative. This thesis has examined that process in detail, in particular the role of the specific granular activated carbon used (Nyex). Nyex was characterised using a range of microscopic and spectroscopic methods. It is a highly crystalline graphite material which has been intercalated with bisulphate ions and water. It has an accessible surface area of 2.04 m2/g and a classic platy morphology with oxygen surface functionality. Additionally, the intercalation process has not changed the inter-layer distance. It is known that graphite intercalation compounds can expand upon thermal treatment. Upon heating using either an oven or a domestic microwave, Nyex expanded rapidly, resulting in an expanded carbon with a very typical vermiform morphology. The maximum expansion volume recorded for Nyex was 394 mL g 1, for microwave expanded Nyex. Surface area analysis confirmed that this volume expansion had not introduced porosity into the structure. The structure was damaged by the expansion but the overall number of defects has decreased. Analytical electrochemistry has been carried out, using Nyex as a working electrode and four test materials. Phenol can be irreversibly oxidised at a Nyex working electrode, and the build-up of breakdown products on the surface can be prevented by the application of 1.85 V for 7 s between each cyclic voltammogram. The increased surface area of expanded Nyex led currents to flow at an order of magnitude higher (approximately 40 µA compared to 5 µA for unexpanded Nyex) meaning more phenol could be oxidised at the same potentials. Humic acid and hydroquinone both showed no electrochemical activity at Nyex. Additionally, repeated cycling of potentials in hydroquinone led to the build-up of carbonaceous material on the surface of the electrode which passivated it. The industry provided test material, Tellus oil, passivated both Nyex and platinum electrodes. Two extraction methods to analyse the quantity of oil left on the Nyex after the Arvia process were developed. Using supercritical CO2 (scCO2) an extraction efficiency of 63% was achieved using 1 hour of extraction. Using acetone extraction, efficiencies in the region of 80 – 90% could be achieved in 10 min. The scCO2 extraction was complex, and required specialist equipment and training. In contrast the acetone extraction was simple and gave more reproducible results. Samples provided by Arvia from their pilot plant trial were extracted using the acetone extraction method. The concentration of oil on the samples was approximately 50 wt.% and did not decrease after 1100 hours of regeneration. A trial was run at Nottingham using 25 wt.% of oil which also did not decrease after 8 hours of regeneration. In summary, the combination of analytical electrochemistry and solvent extraction has shown Nyex is able to absorb up to 50 wt.% of oil from water, but the Arvia process does not destroy complex oily wastes. It is effective at oxidising phenol from water, with cycles of regeneration ensuring the Nyex surface is not passivated by the build-up of breakdown products. Nyex expanded in either the microwave or an oven is capable of oxidising much higher quantities of phenol because of its higher surface area

Interpersonel farvning i dansk

On a systemic functional background this paper presents two central interpersonal resources in Danish, namely the concept of speech function and the concept of modality. Thus, the paper presents linguistic ways to negotiate meaning and to express attitude. The negotiation of meaning and the expression of attitude can be dealt with in both a typical way and a non-typical way. The typical way constitutes the congruent and non-metaphorical mode while the latter constitutes the incongruent mode and thereby the lexicogrammatical metaphor. The paper examines both nonmetaphorical and metaphorical ways of negotiating meaning and expressing attitude

Interpersonel farvning i dansk

On a systemic functional background this paper presents two central interpersonal resources in Danish, namely the concept of speech function and the concept of modality. Thus, the paper presents linguistic ways to negotiate meaning and to express attitude. The negotiation of meaning and the expression of attitude can be dealt with in both a typical way and a non-typical way. The typical way constitutes the congruent and non-metaphorical mode while the latter constitutes the incongruent mode and thereby the lexicogrammatical metaphor. The paper examines both nonmetaphorical and metaphorical ways of negotiating meaning and expressing attitude

Test-retest reliability and agreement of lower-extremity kinematics captured in squatting and jumping preschool children using markerless motion capture technology

The clinimetric properties of new technology should be evaluated in relevant populations before its implementation in research or clinical practice. Markerless motion capture is a new digital technology that allows for data collection in young children without some drawbacks commonly encountered with traditional systems. However, important properties, such as test-retest reliability, of this new technology have so far not been investigated. We recorded 63 preschool children using markerless motion capture (The Captury GmbH, Saarbrüken, Germany) while they performed squats and standing broad jumps. A retest session was conducted after 1 week. Recordings from the test session were processed twice to estimate the software-driven instrumental variability. Recordings from the first and second test sessions were compared to evaluate the week-to-week test-retest reliability. Statistical tests included 95% limits of agreement and intraclass correlations of absolute agreement (ICC). Jump length performance and four kinematic variables demonstrated acceptable instrumental variability (ICC &gt; 0.76). The week-to-week reliability was excellent for jump length performance (ICC = 0.90) but poor to moderate (ICC &lt; 0.55) for the kinematic variables. Our results indicate that preschool children exhibit considerable intra-individual kinematic variation from week-to-week during jump landings and squats. Consequently, we suggest that future work should explore individuals with persistent extreme kinematics over multiple test-sessions

The Nordic maintenance care program: what are the indications for maintenance care in patients with low back pain? A survey of the members of the Danish Chiropractors' Association

<p>Abstract</p> <p>Background</p> <p>Maintenance care (MC) is relatively commonly used among chiropractors. However, factual information is needed on its indications for use.</p> <p>Objectives</p> <p>This study had two objectives: 1) to describe which role patients' past history and treatment outcome play in chiropractors' decision to use MC in patients with low back pain, 2) to investigate if the chiropractors' clinical/educational background has an effect on the frequency of using MC and their indications for use of MC.</p> <p>Method</p> <p>An anonymous questionnaire was sent to all 413 chiropractors practising in Denmark. Its main part consisted of 3 sets of 4 questions relating to one basic case of low back pain. For each case, the chiropractors were asked if they would use MC as they self-defined the term (no/perhaps/yes). There were questions also on gender, age, educational and clinical background, and on the number of MC patients seen by these chiropractors. Their decision to recommend MC was reported. Associations between the demographic variables and 1) the frequency of MC-use and 2) their indications for use of MC were tested through multivariate analysis.</p> <p>Results</p> <p>The response rate was 72%. Non-indications for MC were: 1) a good outcome combined with no previous events, or 2) a past history of LBP and gradual worsening with treatment. Indications for MC were a good outcome combined with a previous history of low back pain between once a month and once a year. The mean proportion of MC patients per week were 22% (SD 19), ranging from 0% to 100%. The use of MC was highest among experienced chiropractors, those who were educated in North America, and clinic owners. However, in Denmark most chiropractors graduated before 1999, are educated abroad, whereas most chiropractors thereafter are educated in Denmark. Therefore, we cannot conclude whether this difference relates to education or years of experience. There were no associations detected between demographic variables and the indications for MC.</p> <p>Conclusions</p> <p>There is relatively high consensus on when MC should and should not be used. A history of prior low back pain combined with a positive response to treatment encourages the use of MC, whereas no previous history of back pain or a worsening of symptoms discourages the use of MC. There seems to be a difference in the proportional use of MC between chiropractors with more experience educated in North America and those with less experience educated in Denmark.</p