Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management

Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme. The programme provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire) and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential programme and at 1 and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen’s d) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this programme. Mean scores on outcome measures showed a similar pattern: improvement after residential programme and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy and 1.3 for physical functioning related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Study results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programmes and spinal surgery for similar conditions (SMR 136 and 98%, respectively). The participants of this evidence-based programme learned to manage CLBP, improved in daily functioning and quality of life. The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes

Gespräch mit Gaius, Jurist in Kleinasien

The only book that has survived the »classical age« Of Roman law (between 50 B.C. and 250) as the relic of an extremely productive period in legal history is the introduction to private law published by Gaius under the title Institutiones during the reign of the Emperor Marcus Aurelius. Our knowledge of this jurist who became more famous in his afterlife than amongst his contemporaries, having a considerable impact on codification in 18th and 19th century Europe, is extremely limited; thus the question arises: Who is Gaius? Theodor Mommsen, after collecting scarce evidence, pleaded for Gaius being a scholar in the remote provinces far from Rome – probably in Asia minor – being in close contact with a small but powerful group of Roman jurists. The text is a variant of this theory: »Conversation with Gaius« is scientific fiction at its best: abundant in material, most plausible in the setting – and maybe the best possible depiction of a scholarly chat in a paradise garden for all those who want to get into conversation with Gaius

In Situ Electrochemistry inside the TEM with Controlled Mass Transport

The field of electrochemistry promises solutions for the future energy crisis and environmental deterioration by developing optimized batteries, fuel-cells and catalysts. Combined with in situ transmission electron microscopy (TEM), it can reveal functional and structural changes. A drawback of this relatively young field is lack of reproducibility in controlling the liquid environment while retaining the imaging and analytical capabilities. Here, a platform for in situ electrochemical studies inside a TEM with a pressure-driven flow is presented, with the capability to control the flow direction and to ensure the liquid will always pass through the region of interest. As a result, the system offers the opportunity to define the mass transport and control the electric potential, giving access to the full kinetics of the redox reaction. In order to show the benefits of the system, copper dendrites are electrodeposited and show reliable electric potential control. Next, their morphology is changed by tuning the mass transport conditions. Finally, at a liquid thickness of approximately 100 nm, the diffraction pattern revealed the 〈1,1,1〉 planes of the copper crystals, indicating an atomic resolution down to 2.15 Å. Such control of the liquid thickness enabled elemental mapping, allowing us to distinguish the spatial distribution of different elements in liquid