Validation of the manual inclinometer and flexicurve for the measurement of thoracic kyphosis

This is the Accepted Manuscript of an article published by Taylor & Francis Group in Physiotherapy Theory and Practice on 7 November 2017, available online at:https://doi.org/10.1080/09593985.2017.1394411. The Accepted Manuscript version is under embargo until 7 November 2018.Introduction: Physiotherapists commonly use the manual inclinometer and Flexicurve for the clinical measurement of thoracic spinal posture. The aim of this study is to examine the concurrent validity of the Flexicurve and manual inclinometer in relation to the radiographic Cobb angle for the measurement of thoracic kyphosis. Methods: Eleven subjects (seven males, four females) underwent a sagittal plane spinal radiograph. Immediately following the radiograph, a physiotherapist measured thoracic kyphosis using the Flexicurve and manual inclinometer before the subjects moved from position. Cobb angles were subsequently measured from the radiographs by an independent examiner. Results: A strong correlation was demonstrated between both the Cobb angle and the Flexicurve angle (r = 0.96) and the Cobb angle and the manual inclinometer angle (r = 0.86). On observation of the Bland–Altman plots, the inclinometer showed good agreement with the Cobb angle (mean difference 4.8 ° ± 8.9 °). However, the Flexicurve angle was systematically smaller than the Cobb angle (mean difference 20.3 ° ± 6.1 °), which reduces its validity. Conclusion: The manual inclinometer is recommended as a valid instrument for measuring thoracic kyphosis, with good agreement with the gold standard. While the Flexicurve is highly correlated to the gold standard, they have poor agreement. Therefore, physiotherapists should take caution when interpreting its results.Peer reviewedFinal Accepted Versio

Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review

This document is the Accepted Manuscript version of the following article: Eva Barrett, Mary O'Keeffe, Kieran O'Sullivan, Jeremy Lewis, and Karen McCreesh, 'Is thoracic spine posture associated with shoulder pain, range of motion and function?: A systematic review', Manual Therapy, Vol. 26: 38-46, December 2016, doi: https://doi.org/10.1016/j.math.2016.07.008. This Manuscript version is made available under the terms of the CC Commons Attribution-NonCommercial-NoDerivatives License CC BY NC-NC 4.0 ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.IntroductionExcessive thoracic kyphosis is considered a predisposing factor for shoulder pain, though there is uncertainty about the nature of the relationship between shoulder pain and thoracic spine posture. The aim of this systematic review was to investigate the relationship between thoracic kyphosis and shoulder pain, shoulder range of motion (ROM) and function.MethodsTwo reviewers independently searched eight electronic databases and identified relevant studies by applying eligibility criteria. Sources of bias were assessed independently by two reviewers using a previously validated tool (Ijaz et al., 2013). Data were synthesised using a level of evidence approach (van Tulder et al., 2003).ResultsTen studies were included. Four studies were rated as low risk of bias, three at moderate risk of bias and three at high risk of bias. There is a moderate level of evidence of no significant difference in thoracic kyphosis between groups with and without shoulder pain. One study at high risk of bias demonstrated significantly greater thoracic kyphosis in people with shoulder pain (p < 0.05). There is a strong level of evidence that maximum shoulder ROM is greater in erect postures compared to slouched postures (p < 0.001), in people with and without shoulder pain.ConclusionsThoracic kyphosis may not be an important contributor to the development of shoulder pain. While there is evidence that reducing thoracic kyphosis facilitates greater shoulder ROM, this is based on single-session studies whose long-term clinical relevance is unclear. Higher quality research is warranted to fully explore the role of thoracic posture in shoulder pain.Peer reviewedFinal Accepted Versio

Medicare Prescription Drug Benefit: An Overview of Implementation for Dual Eligibles

This report provides background information on the early stages of the implementation of the Medicare Part D outpatient prescription drug program. This report describes certain policies and implementation issues related to those who are not dually eligible

Active buildings in the changing policy landscape: conceptual challenges and social scientific perspectives

As significant contributors to global CO2 and other GHG emissions globally, it is recognised that the energy and buildings sectors must find ways to decarbonise in order that climate change targets may be realised. For the energy sector, increasing levels of renewable energy production at all scales presents challenges for national electricity grids in matching supply to demand. Buildings as places of energy consumption and increasingly energy production, may become places for the intelligent storage and consumption of energy, providing grid flexibility through more complete integration into energy systems. Active buildings present a contemporary conceptualisation for addressing such environmental policy, technical and societal problems, incorporating low carbon building fabric design, renewable energy production and energy storage capacity with intelligent digitalisation. It is directed towards facilitating the scale-up of single buildings to neighbourhoods and beyond. With a number of building certifications, labels and conceptualisations already in existence, active buildings must offer a clear progression and differentiation of those already existing. A key factor under-represented in some existing concepts is understanding of the many diverse and valued roles that building play in society, as material places of commerce, education, healthcare, or home. Buildings, in all forms also have subjective and powerful values and meanings attached to them. For homes, these are formed through a multitude of factors; people’s past and anticipated future, life course transitions, social relationships, as well as wider social, economic and political contexts and structures, all of which vary in how they assemble in space and time. Such factors together also hold influence over how people carry out their everyday and energy practices. As buildings as homes are imagined as playing a dynamic role in future energy infrastructure, understanding the interplay between people, homes and energy and how this may alter as imaginaries are realised is essential to them fulfilling their many requirements. Adopting a social science lens, this paper outlines key international building certification schemes and conceptualisations, including their strengths and weaknesses, that should be drawn on in the formation of active buildings as homes. It also takes account of the changing policy and energy landscapes in the UK and raises critical questions for the conceptualisation of active buildings as active homes

Salivary cortisol levels in Parkinson's disease and its correlation to risk behaviour

Objective To investigate salivary cortisol samples in patients with Parkinson's disease (PD) with and without impulsive compulsive behaviours (ICB) during a risk task.Methods Salivary cortisol levels were measured in 13 PD patients without ICB (PD-ICB) and in 15 PD patients with ICB (PD+ICB) before, after medication and throughout the day, and were compared with results with 14 healthy controls. All participants also performed a gambling task to assess risk taking behaviour.Results Significantly higher diurnal cortisol levels were found in the PD-ICB group compared with healthy controls but no differences were seen between the PD+ICB and the control group. Increased cortisol levels were significantly correlated with increased risk taking in PD+ICB patients but no interaction was found in the PD-ICB group.Conclusions The findings are in keeping with previous studies which have linked low cortisol levels with antisocial behaviour. The higher cortisol levels during the risk task in the PD+ICB group are consistent with reports in pathological gamblers during gambling and addicts during drug abuse. The results support the hypothesis that cortisol plays an important role in risk taking in ICBs

Identity, place narrative and biophilic urban development: Connecting the past, present and future for sustainable liveable cities

Urbanization presents sustainability challenges for the natural environment, resources and ecological systems, whilst high levels of pollution and disconnect from the natural environment can adversely impact the health and wellbeing of urban residents. Rapid urbanisation can also curtail processes of placemaking, including place attachment and place identity, raising questions around the social sustainability and liveability of cities into the future. With such concerns in mind, cities are increasingly called upon to develop in ways that are environmentally, socially, and economically sustainable. The concept of biophilia has been applied to sustainable urban development, in which nature and green infrastructure are systematically incorporated into cities to reduce adverse impacts to the natural environment while supporting the social, cultural and economic sustainability of communities. This paper explores findings from community focus groups centred on perceptions of a proposed biophilic urban development in Wales, UK. We highlight how community members understand and negotiate possible impacts the development may have on the city by drawing on their own emplaced experiences, as well as their perception of the city in relation to broader contexts of economic crisis and environmental change. We highlight the importance of temporally and spatially situated understandings of innovative building developments, as part of sustainable urban developments, and how such transformative processes should enable community place-making, and as such become valued, and sustained through time

Transformational innovation in home energy: How developers imagine and engage with future residents of low carbon homes in the United Kingdom

Decarbonisation and climate change targets require multiscale sociotechnical energy transitions that include significant changes to housing stock. In the UK, the development of Active Buildings, which directly seek to be efficient energy producers, have zero carbon emissions and provide grid flexibility, has the potential to make a significant contribution to meeting these targets. Active Homes as a particular type of Active Building represent a potentially transformational innovation by altering how energy is produced, distributed and consumed, in addition to how homes are designed, constructed and then lived in. In this paper we draw on insights from qualitative interviews with stakeholders involved in the development of different Active Homes to consider motivations for development, and their views on how residents will reside in and interact with the homes. We highlight a potential conflict between a desire to prioritise the needs of residents with a belief amongst some that to do so, user engagement with technology should be minimised. This has implications for design decisions, which in turn influence how residents experience and live within the homes. In illuminating these narratives, we indicate the necessity of ongoing engagement with residents to understand how Active Homes – with particular emphasis on the operation and control of technologies – are experienced, in order to inform the successful rollout of current and future developments

Living well in low carbon homes project report

Final report for the Living Well in Low Carbon Homes Project, part of the Active Building Centre Research Programm

Oleoylethanolamine and palmitoylethanolamine modulate intestinal permeability in vitro via TRPV1 and PPARα

Cannabinoids modulate intestinal permeability through cannabinoid receptor 1 (CB1). The endocannabinoid-like compounds oleoylethanolamine (OEA) and palmitoylethanolamine (PEA) play an important role in digestive regulation, and we hypothesized they would also modulate intestinal permeability. Transepithelial electrical resistance (TEER) was measured in human Caco-2 cells to assess permeability after application of OEA and PEA and relevant antagonists. Cells treated with OEA and PEA were stained for cytoskeletal F-actin changes and lysed for immunoassay. OEA and PEA were measured by liquid chromatography–tandem mass spectrometry. OEA (applied apically, logEC50 −5.4) and PEA (basolaterally, logEC50 −4.9; apically logEC50 −5.3) increased Caco-2 resistance by 20–30% via transient receptor potential vanilloid (TRPV)-1 and peroxisome proliferator-activated receptor (PPAR)-α. Preventing their degradation (by inhibiting fatty acid amide hydrolase) enhanced the effects of OEA and PEA. OEA and PEA induced cytoskeletal changes and activated focal adhesion kinase and ERKs 1/2, and decreased Src kinases and aquaporins 3 and 4. In Caco-2 cells treated with IFNγ and TNFα, OEA (via TRPV1) and PEA (via PPARα) prevented or reversed the cytokine-induced increased permeability compared to vehicle (0.1% ethanol). PEA (basolateral) also reversed increased permeability when added 48 or 72 h after cytokines (P < 0.001, via PPARα). Cellular and secreted levels of OEA and PEA (P < 0.001–0.001) were increased in response to inflammatory mediators. OEA and PEA have endogenous roles and potential therapeutic applications in conditions of intestinal hyperpermeability and inflammation