Patients' and physiotherapists' perspectives on implementing a tailored stratified treatment approach for low back pain in Nigeria: a qualitative study

Background: Stratified care has the potential to be efficient in addressing the physical and psychosocial components of low back pain (LBP) and optimise treatment outcomes essential in low-income countries. This study aimed to investigate the perceptions of physiotherapists and patients in Nigeria towards stratified care for the treatment of LBP, exploring barriers and enablers to implementation. Methods: A qualitative design with semistructured individual telephone interviews for physiotherapists and patients with LBP comprising research evidence and information on stratified care was adopted. Preceding the interviews, patients completed the Subgroups for Targeted Treatment tool. The interviews were recorded, transcribed and analysed following grounded theory methodology. Results: Twelve physiotherapists and 13 patients with LBP participated in the study (11 female, mean age 42.8 (SD 11.47) years). Seven key categories emerged: recognising the need for change, acceptance of innovation, resistance to change, adapting practice, patient's learning journey, trusting the therapist and needing conviction. Physiotherapists perceived stratified care to be a familiar approach based on their background training. The prevalent treatment tradition and the patient expectations were seen as major barriers to implementation of stratified care by the physiotherapists. Patients see themselves as more informed than therapists realise, yet they need conviction through communication and education to cooperate with their therapist using this approach. Viable facilitators were also identified as patients' trust in the physiotherapist and adaptations in terms of training and modification of the approach to enhance its use. Conclusion: Key barriers identified are the patients' treatment expectations and physiotherapists' adherence to the tradition of practice. Physiotherapists might facilitate implementation of the stratified care by communication, hierarchical implementation and utilisation of patients' trust. Possibilities to develop a consensus on key strategies to overcome barriers and on utilisation of facilitators should be tested in future research

Nuclear-fission studies with relativistic secondary beams: analysis of fission channels

Nuclear fission of several neutron-deficient actinides and pre-actinides from excitation energies around 11 MeV was studied at GSI Darmstadt by use of relativistic secondary beams. The characteristics of multimodal fission of nuclei around 226Th are systematically investigated and interpreted as the superposition of three fission channels. Properties of these fission channels have been determined for 15 systems. A global view on the properties of fission channels including previous results is presented. The positions of the asymmetric fission channels are found to be constant in element number over the whole range of systems investigated.Comment: 16 pages, 3 figures, background information on http://www.gsi.de/charm

Electromagnetic-induced fission of 238U projectile fragments, a test case for the production of spherical super-heavy nuclei

Isotopic series of 58 neutron-deficient secondary projectiles (205,206At, 205-209Rn, 208-212,217,218Fr, 211-223Ra, 215-226Ac, 221-229Th, 226-231Pa, 231-234U) were produced by projectile fragmentation using a 1 A GeV 238U beam. Cross sections of fission induced by nuclear and electromagnetic interactions in a secondary lead target were measured. They were found to vary smoothly as a function of proton and neutron number of the fissioning system, also for nuclei with large ground-state shell effects near the 126-neutron shell. No stabilization against fission was observed for these nuclei at low excitation energies. Consequences for the expectations on the production cross sections of super-heavy nuclei are discussed.Comment: 20 pages, 13 figure

Author's personal copy LAMINAR-SPECIFIC AND DEVELOPMENTAL EXPRESSION OF AQUAPORIN-4 IN THE MOUSE HIPPOCAMPUS

Abstract-Mice deficient in the water channel aquaporin-4 (AQP4) demonstrate increased seizure duration in response to hippocampal stimulation as well as impaired extracellular K ؉ clearance. However, the expression of AQP4 in the hippocampus is not well described. In this study, we investigated (i) the developmental, laminar and cell-type specificity of AQP4 expression in the hippocampus; (ii) the effect of Kir4.1 deletion on AQP4 expression; and (iii) performed Western blot and RT-PCR analyses. AQP4 immunohistochemistry on coronal sections from wild-type (WT) or Kir4.1 ؊/؊ mice revealed a developmentally-regulated and laminar-specific pattern, with highest expression in the CA1 stratum lacunosum-moleculare (SLM) and the molecular layer (ML) of the dentate gyrus (DG). AQP4 was colocalized with the glial markers glial fibrillary acidic protein (GFAP) and S100␤ in the hippocampus, and was also ubiquitously expressed on astrocytic endfeet around blood vessels. No difference in AQP4 immunoreactivity was observed in Kir4.1 ؊/؊ mice. Electrophysiological and postrecording RT-PCR analyses of individual cells revealed that AQP4 and Kir4.1 were co-expressed in nearly all CA1 astrocytes. In NG2 cells, AQP4 was also expressed at the transcript level. This study is the first to examine subregional AQP4 expression during development of the hippocampus. The strikingly high expression of AQP4 in the CA1 SLM and DG ML identifies these regions as potential sites of astrocytic K ؉ and H 2 O regulation. These results begin to delineate the functional capabilities of hippocampal subregions and cell types for K ؉ and H 2 O homeostasis, which is critical to excitability and serves as a potential target for modulation in diverse diseases

Process evaluation of five tailored programs to improve the implementation of evidence-based recommendations for chronic conditions in primary care

Background: Although there is evidence that tailored implementation strategies can be effective, there is little evidence on which methods of tailoring improve the effect. We designed and evaluated five tailored programs (TPs) each consisting of various strategies. The aim of this study was to examine (a) how determinants of practice prioritized in the design phase of the TPs were perceived by health care professionals who had been exposed to the TPs and whether they suggested other important determinants of practice and (b) how professionals used the offered strategies and whether they suggested other strategies that might have been more effective. Methods: We conducted a mixed-method process evaluation linked to five cluster-randomized trials carried out in five European countries to implement recommendations for five chronic conditions in primary care settings. The five TPs used a total of 28 strategies which aimed to address 38 determinants of practice. Interviews of professionals in the intervention groups and a survey of professionals in the intervention and control groups were performed. Data collection was conducted by each research team in the respective national language. The interview data were first analyzed inductively by each research team, and subsequently, a meta-synthesis was conducted. The survey was analyzed descriptively. Results: We conducted 71 interviews; 125 professionals completed the survey. The survey showed that 76% (n = 29) of targeted determinants of practice were perceived as relevant and 95% (n = 36) as being modified by the implementation interventions by 66 to 100% of professionals. On average, 47% of professionals reported using the strategies and 51% considered them helpful, albeit with substantial variance between countries and strategies. In the interviews, 89 determinants of practice were identified, of which 70% (n = 62) had been identified and 45% (n = 40) had been prioritized in the design phase. The interviewees suggested 65 additional strategies, of which 54% (n = 35) had been identified and 20% (n = 13) had been prioritized, but not selected in the final programs. Conclusions: This study largely confirmed the perceived relevance of the targeted determinants of practice. This contrasts with the fact that no impact of the trials on the implementation of the recommendations could be observed. The findings suggest that better methods for prioritization of determinants and strategies are needed. Trial registration: Each of the five trials was registered separately in recognized trial registries. Details are given in the respective trial outcome papers

Anisotropic Panglial Coupling Reflects Tonotopic Organization in the Inferior Colliculus

Astrocytes and oligodendrocytes in different brain regions form panglial networks and the topography of such networks can correlate with neuronal topography and function. Astrocyte-oligodendrocyte networks in the lateral superior olive (LSO)—an auditory brainstem nucleus—were found to be anisotropic with a preferred orientation orthogonally to the tonotopic axis. We hypothesized that such a specialization might be present in other tonotopically organized brainstem nuclei, too. Thus, we analyzed gap junctional coupling in the center of the inferior colliculus (IC)—another nucleus of the auditory brainstem that exhibits tonotopic organization. In acute brainstem slices obtained from mice, IC networks were traced employing whole-cell patch-clamp recordings of single sulforhodamine (SR) 101-identified astrocytes and concomitant intracellular loading of the gap junction-permeable tracer neurobiotin. The majority of dye-coupled networks exhibited an oval topography, which was preferentially oriented orthogonal to the tonotopic axis. Astrocyte processes showed preferentially the same orientation indicating a correlation between astrocyte and network topography. In addition to SR101-positive astrocytes, IC networks contained oligodendrocytes. Using Na+ imaging, we analyzed the capability of IC networks to redistribute small ions. Na+ bi-directionally diffused between SR101-positive astrocytes and SR101-negative cells—presumably oligodendrocytes—showing the functionality of IC networks. Taken together, our results demonstrate that IC astrocytes and IC oligodendrocytes form functional anisotropic panglial networks that are preferentially oriented orthogonal to the tonotopic axis. Thus, our data indicate that the topographic specialization of glial networks seen in IC and LSO might be a general feature of tonotopically organized auditory brainstem nuclei

Limits on the production of direct photons in 200 A GeV32^{32}S + Au collisions

A search for the production of direct photons in S+Au collisions at 200\cdotA~GeV has been carried out in the CERN-WA80 experiment. For central collisions the measured photon excess at each p_T, averaged over the range 0.5~GeV/c~ \leq p_T \leq 2.5~GeV/c, corresponded to 5.0\% of the total inclusive photon yield with a statistical error of \sigma_{\rm stat}=0.8\% and a systematic error of \sigma_{\rm syst}=5.8\%. Upper limits on the invariant yield for direct photon production at the 90\%~C.L. are presented. Possible implications for the dynamics of high-energy heavy-ion collisions are discussed