Inferential reproduction analysis demonstrated that “paracetamol for acute low back pain” trial conclusions were reproducible

Objectives: The aim of this study was to reanalyze and reinterpret data obtained in Paracetamol in Acute Low Back Pain (PACE), the first large randomized controlled trial evaluating the efficacy of paracetamol in acute low back pain, to assess the inferential reproducibility of the original conclusions. Study Design and Setting: Mixed effects models were used to reanalyze pain intensity (primary outcome; 11-point Numeric Rating Scale) and physical functioning, health-related quality of life, sleep quality, and time until recovery (as secondary outcomes), according to the intention-to-treat principle. The original authors of the PACE study were not involved in the development of the methods for this reanalysis. Results: The reproduction analyses indicated no effect of treatment on pain intensity and confidence intervals excluded clinically worthwhile effects (adjusted main effect for regular paracetamol vs. placebo 0.00 [−0.02, 0.01; P = 0.85]; adjusted main effect for paracetamol as-needed vs. placebo 0.00 [−0.02, 0.01; P = 0.92]). Similar results were obtained for all secondary outcomes. Conclusion: This study indicates that the conclusions of the PACE trial are inferentially reproducible, even when using a different analytical approach. This reinforces the notion that the management of acute low back pain should focus on providing patients advice and reassurance without the addition of paracetamol

Stokes Diagnostis of 2D MHD-simulated Solar Magnetogranulation

We study the properties of solar magnetic fields on scales less than the spatial resolution of solar telescopes. A synthetic infrared spectropolarimetric diagnostics based on a 2D MHD simulation of magnetoconvection is used for this. We analyze two time sequences of snapshots that likely represent two regions of the network fields with their immediate surrounding on the solar surface with the unsigned magnetic flux density of 300 and 140 G. In the first region we find from probability density functions of the magnetic field strength that the most probable field strength at logtau_5=0 is equal to 250 G. Weak fields (B < 500 G) occupy about 70% of the surface, while stronger fields (B 1000 G) occupy only 9.7% of the surface. The magnetic flux is -28 G and its imbalance is -0.04. In the second region, these parameters are correspondingly equal to 150 G, 93.3 %, 0.3 %, -40 G, and -0.10. We estimate the distribution of line-of-sight velocities on the surface of log tau_5=-1. The mean velocity is equal to 0.4 km/s in the first simulated region. The averaged velocity in the granules is -1.2 km/s and in the intergranules is 2.5 km/s. In the second region, the corresponding values of the mean velocities are equal to 0, -1.8, 1.5 km/s. In addition we analyze the asymmetry of synthetic Stokes-V profiles of the Fe I 1564.8 nm line. The mean values of the amplitude and area asymmetry do not exceed 1%. The spatially smoothed amplitude asymmetry is increased to 10% while the area asymmetry is only slightly varied.Comment: 24 pages, 12 figure

Magnetic field diagnostics and spatio-temporal variability of the solar transition region

Magnetic field diagnostics of the transition region from the chromosphere to the corona faces us with the problem that one has to apply extreme UV spectro-polarimetry. While for coronal diagnostic techniques already exist through infrared coronagraphy above the limb and radio observations on the disk, for the transition region one has to investigate extreme UV observations. However, so far the success of such observations has been limited, but there are various projects to get spectro-polarimetric data in the extreme UV in the near future. Therefore it is timely to study the polarimetric signals we can expect for such observations through realistic forward modeling. We employ a 3D MHD forward model of the solar corona and synthesize the Stokes I and Stokes V profiles of C IV 1548 A. A signal well above 0.001 in Stokes V can be expected, even when integrating for several minutes in order to reach the required signal-to-noise ratio, despite the fact that the intensity in the model is rapidly changing (just as in observations). Often this variability of the intensity is used as an argument against transition region magnetic diagnostics which requires exposure times of minutes. However, the magnetic field is evolving much slower than the intensity, and thus when integrating in time the degree of (circular) polarization remains rather constant. Our study shows the feasibility to measure the transition region magnetic field, if a polarimetric accuracy on the order of 0.001 can be reached, which we can expect from planned instrumentation.Comment: Accepted for publication in Solar Physics (4.Mar.2013), 19 pages, 9 figure

Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

Objective: The aim of this study was to provide an overview of the recommendations regarding the diagnosis and treatment contained in current clinical practice guidelines for patients with non-specific low back pai

Shadowing Effects on Vector Boson Production

We explore how nuclear modifications to the nucleon structure functions, shadowing, affect massive gauge boson production in heavy ion collisions at different impact parameters. We calculate the dependence of $Z^0$, $W^+$ and $W^-$ production on rapidity and impact parameter to next-to-leading order in Pb+Pb collisions at 5.5 TeV/nucleon to study quark shadowing at high $Q^2$. We also compare our Pb+Pb results to the $pp$ rapidity distributions at 14 TeV.Comment: 25 pages ReVTeX, 12 .eps figures, NLO included, version accepted for publication in Physical Review

Small-scale solar magnetic fields

As we resolve ever smaller structures in the solar atmosphere, it has become clear that magnetism is an important component of those small structures. Small-scale magnetism holds the key to many poorly understood facets of solar magnetism on all scales, such as the existence of a local dynamo, chromospheric heating, and flux emergence, to name a few. Here, we review our knowledge of small-scale photospheric fields, with particular emphasis on quiet-sun field, and discuss the implications of several results obtained recently using new instruments, as well as future prospects in this field of research.Comment: 43 pages, 18 figure

Solar Intranetwork Magnetic Elements: bipolar flux appearance

The current study aims to quantify characteristic features of bipolar flux appearance of solar intranetwork (IN) magnetic elements. To attack such a problem, we use the Narrow-band Filter Imager (NFI) magnetograms from the Solar Optical Telescope (SOT) on board \emph{Hinode}; these data are from quiet and an enhanced network areas. Cluster emergence of mixed polarities and IN ephemeral regions (ERs) are the most conspicuous forms of bipolar flux appearance within the network. Each of the clusters is characterized by a few well-developed ERs that are partially or fully co-aligned in magnetic axis orientation. On average, the sampled IN ERs have total maximum unsigned flux of several 10^{17} Mx, separation of 3-4 arcsec, and a lifetime of 10-15 minutes. The smallest IN ERs have a maximum unsigned flux of several 10^{16} Mx, separations less than 1 arcsec, and lifetimes as short as 5 minutes. Most IN ERs exhibit a rotation of their magnetic axis of more than 10 degrees during flux emergence. Peculiar flux appearance, e.g., bipole shrinkage followed by growth or the reverse, is not unusual. A few examples show repeated shrinkage-growth or growth-shrinkage, like magnetic floats in the dynamic photosphere. The observed bipolar behavior seems to carry rich information on magneto-convection in the sub-photospheric layer.Comment: 26 pages, 14 figure

Triggering an eruptive flare by emerging flux in a solar active-region complex

A flare and fast coronal mass ejection originated between solar active regions NOAA 11514 and 11515 on July 1, 2012 in response to flux emergence in front of the leading sunspot of the trailing region 11515. Analyzing the evolution of the photospheric magnetic flux and the coronal structure, we find that the flux emergence triggered the eruption by interaction with overlying flux in a non-standard way. The new flux neither had the opposite orientation nor a location near the polarity inversion line, which are favorable for strong reconnection with the arcade flux under which it emerged. Moreover, its flux content remained significantly smaller than that of the arcade (approximately 40 %). However, a loop system rooted in the trailing active region ran in part under the arcade between the active regions, passing over the site of flux emergence. The reconnection with the emerging flux, leading to a series of jet emissions into the loop system, caused a strong but confined rise of the loop system. This lifted the arcade between the two active regions, weakening its downward tension force and thus destabilizing the considerably sheared flux under the arcade. The complex event was also associated with supporting precursor activity in an enhanced network near the active regions, acting on the large-scale overlying flux, and with two simultaneous confined flares within the active regions.Comment: Accepted for publication in Topical Issue of Solar Physics: Solar and Stellar Flares. 25 pages, 12 figure

PRECISE - pregabalin in addition to usual care for sciatica: Study protocol for a randomised controlled trial

Background: Sciatica is a type of neuropathic pain that is characterised by pain radiating into the leg. It is often accompanied by low back pain and neurological deficits in the lower limb. While this condition may cause significant suffering for the individual, the lack of evidence supporting effective treatments for sciatica makes clinical management difficult. Our objectives are to determine the efficacy of pregabalin on reducing leg pain intensity and its cost-effectiveness in patients with sciatica.Methods/Design: PRECISE is a prospectively registered, double-blind, randomised placebo-controlled trial of pregabalin compared to placebo, in addition to usual care. Inclusion criteria include moderate to severe leg pain below the knee with evidence of nerve root/spinal nerve involvement. Participants will be randomised to receive either pregabalin with usual care (n = 102) or placebo with usual care (n = 102) for 8 weeks. The medicine dosage will be titrated up to the participant's optimal dose, to a maximum 600 mg per day. Follow up consultations will monitor individual progress, tolerability and adverse events. Usual care, if deemed appropriate by the study doctor, may include a referral for physical or manual therapy and/or prescription of analgesic medication. Participants, doctors and researchers collecting participant data will be blinded to treatment allocation. Participants will be assessed at baseline and at weeks 2, 4, 8, 12, 26 and 52. The primary outcome will determine the efficacy of pregabalin in reducing leg pain intensity. Secondary outcomes will include back pain intensity, disability and quality of life. Data analysis will be blinded and by intention-to-treat. A parallel economic evaluation will be conducted from health sector and societal perspectives.Discussion: This study will establish the efficacy of pregabalin in reducing leg pain intensity in patients with sciatica and provide important information regarding the effect of pregabalin treatment on disability and quality of life. The impact of this research may allow the future development of a cost-effective conservative treatment strategy for patients with sciatica.Trial registration: ClinicalTrial.gov, ACTRN 12613000530729

Physics of Solar Prominences: II - Magnetic Structure and Dynamics

Observations and models of solar prominences are reviewed. We focus on non-eruptive prominences, and describe recent progress in four areas of prominence research: (1) magnetic structure deduced from observations and models, (2) the dynamics of prominence plasmas (formation and flows), (3) Magneto-hydrodynamic (MHD) waves in prominences and (4) the formation and large-scale patterns of the filament channels in which prominences are located. Finally, several outstanding issues in prominence research are discussed, along with observations and models required to resolve them.Comment: 75 pages, 31 pictures, review pape