Exploring the use of manual therapy as an adjunctive therapy to 'care as usual' on outcomes in chronic migraine.

Although chronic migraine (CM) has an estimated of worldwide annual prevalence of between1.4% and 2.2%, with the greatest impact on females, the understanding of its pathophysiology is still largely unknown. This has led to a lack of effective treatments and at the time of this study Onabotulinumtoxin A (Botox) was the only medication licensed specifically for CM. However, whilst there are other treatment options, including psychological and physical therapies, their effectiveness in CM is uncertain. A rationale for the use of MT in CM was developed from a narrative review, with a systematic literature review of peer reviewed publications confirming limited research into the role of MT in the treatment of CM. The aim of this study was therefore to explore the effectiveness of manual therapy (MT) as an adjunctive treatment to 'care as usual' in females with CM, using a pragmatic, randomised controlled trial (RCT) in a tertiary headache clinic. Sixty-four female participants with severe CM were randomised into two groups: 'care as usual' and 'care as usual' with MT. The primary outcome was the between group difference in change scores using the Headache Impact Test (HIT6). Secondary outcomes included Patient Global Impression of Change (PGIC) and responder rates. The primary outcome favoured the use of adjunctive treatment with a significant difference in between-group HIT6 change scores. The MT group also had significantly higher responder rates in the HIT6 and PGIC outcomes. The presence of higher baseline levels of cutaneous allodynia, negative coping and emotional distress indicated a greater benefit from the combined MT/ 'care as usual' intervention than 'care as usual' alone. This was the first MT-CM RCT to take place in a UK tertiary NHS headache clinic and contributed new knowledge in several areas: (1) the first use of PGIC outcomes to be reported in an adjunctive CM study which suggested it provides a broader and potentially more patient centred measure of treatment effectiveness, compared to the HIT6 alone. (2) the potential to use movement between allodynia symptom checklist (ASC) categories as a better indication of reduction in allodynia brought about by MT rather than the normal dichotomous cut off score. (3) the first MT-CM study to examine psychological factors and propose that 'care as usual' treatment may be reinforcing negative coping behaviours and maintaining disability in treatment of CM. This study contributes to a body of knowledge on MT for CM, and concluded that MT plus 'care as usual' produced better outcomes versus 'care as usual' alone in females severely affected by CM

The Color-Magnitude Relation in Coma: Clues to the Age and Metallicity of Cluster Populations

We have observed three fields of the Coma cluster of galaxies with a narrow band (modified Stromgren) filter system. Observed galaxies include 31 in the vicinity of NGC 4889, 48 near NGC 4874, and 60 near NGC 4839 complete to M_5500=-18 in all three subclusters. Spectrophotometric classification finds all three subclusters of Coma to be dominated by red, E type (ellipticals/S0's) galaxies with a mean blue fraction, f_B, of 0.10. The blue fraction increases to fainter luminosities, possible remnants of dwarf starburst population or the effects of dynamical friction removing bright, blue galaxies from the cluster population by mergers. We find the color-magnitude (CM) relation to be well defined and linear over the range of M_5500=-13 to -22. After calibration to multi-metallicity models, bright ellipticals are found to have luminosity weighted mean [Fe/H] values between -0.5 and +0.5, whereas low luminosity ellipticals have [Fe/H] values ranging from -2 to solar. The lack of CM relation in our continuum color suggests that a systematic age effect cancels the metallicity effects in this bandpass. This is confirmed with our age index which finds a weak correlation between luminosity and mean stellar age in ellipticals such that the stellar populations of bright ellipticals are 2 to 3 Gyrs younger than low luminosity ellipticals.Comment: 26 pages AAS LaTeX, 6 figures, accepted for publication in A

Operators whose dual has non-separable range

Let $X$ and $Y$ be separable Banach spaces and $T:X\to Y$ be a bounded linear operator. We characterize the non-separability of $T^*(Y^*)$ by means of fixing properties of the operator $T$.Comment: 20 pages, no figure

Report from the PredictER Expert Panel Meeting, November 2, 2007

On November 2, 2007, the Indiana University Center for Bioethics convened an expert panel on predictive health research (PHR) as part of the Center’s Program in Predictive Health Ethics Research (http://www.bioethics.iu.edu/predicter.asp) which is supported by a grant from the Richard M. Fairbanks Foundation. The goal of this meeting was to identify the major obstacles and opportunities for engaging the community in PHR. PredictER intends to use the results of this meeting as a first step toward more fully engaging the Indianapolis community in discussions about PHR.Richard M. Fairbanks Foundatio

The Age of Ellipticals and the Color-Magnitude Relation

Using new narrowband color observations of early-type galaxies in clusters, we reconstruct the color-magnitude relation (CMR) with a higher degree of accuracy than previous work. We then use the spectroscopically determined ages and metallicities from three samples (Trager et al 2008, Thomas et al 2005, Gallazzi et al 2006), combined with multi-metallicity SED models, to compare predicted colors for galaxies with young ages (less than 8 Gyr) with the known CMR. We find that the CMR cannot by reproduced by the spectroscopically determined ages and metallicities in any of the samples despite the high internal accuracies to the spectroscopic indices. In contrast, using only the $$ index to determine [Fe/H], and assuming a mean age of 12 Gyr for a galaxy's stellar population, we derive colors that exactly match not only the color zeropoint of the CMR but also its slope. We consider the source of young age estimates, the H$\beta$ index, and examine the conflict between red continuum colors and large H$\beta$ values in galaxy spectra. We conclude that our current understanding of stellar populations is insufficient to correctly interpret H$\beta$ values and that the sum of our galaxy observations supports an old and monolithic scenario of galaxy formation. This result has a devastating impact on every study that has used the H$\beta$ index to calculate galaxy age, as the use of the H$\beta$ versus MgFe diagram will result in incorrectly deduced young ages.Comment: 29 pages, 9 figures. This version deviates from the version accepted by Ap

The Galaxy Population of Abell 1367: The Stellar Mass-Metallicity Relation

Using wide baseline broad-band photometry, we analyse the stellar population properties of a sample of 72 galaxies, spanning a wide range of stellar masses and morphological types, in the nearby spiral-rich and dynamically young galaxy cluster Abell 1367. The sample galaxies are distributed from the cluster centre out to approximately half the cluster Abell radius. The optical/near-infrared colours are compared with simple stellar population synthesis models from which the luminosity-weighted stellar population ages and metallicities are determined. The locus of the colours of elliptical galaxies traces a sequence of varying metallicity at a narrow range of luminosity-weighted stellar ages. Lenticular galaxies in the red sequence, however, exhibit a substantial spread of luminosity-weighted stellar metallicities and ages. For red sequence lenticular galaxies and blue cloud galaxies, low mass galaxies tend to be on average dominated by stellar populations of younger luminosity-weighted ages. Sample galaxies exhibit a strong correlation between integrated stellar mass and luminosity-weighted stellar metallicity. Galaxies with signs of morphological disturbance and ongoing star formation activity, tend to be underabundant with respect to passive galaxies in the red sequence of comparable stellar masses. We argue that this could be due to tidally-driven gas flows toward the star-forming regions, carrying less enriched gas and diluting the pre-existing gas to produce younger stellar populations with lower metallicities than would be obtained prior to the interaction. Finally, we find no statistically significant evidence for changes in the luminosity-weighted ages and metallicities for either red sequence or blue cloud galaxies, at fixed stellar mass, with location within the cluster.Comment: 15 pages, 10 figures, MNRAS in pres