Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review

Tendinopathy can be resistant to treatment and often recurs, implying that current treatment approaches are suboptimal. Rehabilitation programmes that have been successful in terms of pain reduction and return to sport outcomes usually include strength training. Muscle activation can induce analgesia, improving self-efficacy associated with reducing one's own pain. Furthermore, strength training is beneficial for tendon matrix structure, muscle properties and limb biomechanics. However, current tendon rehabilitation may not adequately address the corticospinal control of the muscle, which may result in altered control of muscle recruitment and the consequent tendon load, and this may contribute to recalcitrance or symptom recurrence. Outcomes of interest include the effect of strength training on tendon pain, corticospinal excitability and short interval cortical inhibition. The aims of this concept paper are to: (1) review what is known about changes to the primary motor cortex and motor control in tendinopathy, (2) identify the parameters shown to induce neuroplasticity in strength training and (3) align these principles with tendon rehabilitation loading protocols to introduce a combination approach termed as tendon neuroplastic training. Strength training is a powerful modulator of the central nervous system. In particular, corticospinal inputs are essential for motor unit recruitment and activation; however, specific strength training parameters are important for neuroplasticity. Strength training that is externally paced and akin to a skilled movement task has been shown to not only reduce tendon pain, but modulate excitatory and inhibitory control of the muscle and therefore, potentially tendon load. An improved understanding of the methods that maximise the opportunity for neuroplasticity may be an important progression in how we prescribe exercise-based rehabilitation in tendinopathy for pain modulation and potentially restoration of the corticospinal control of the muscle-tendon complex

The views of general practitioners and practice nurses towards the barriers and facilitators of proactive, internet-based chlamydia screening for reaching young heterosexual men

Background: Chlamydia trachomatis is a common bacterial sexually transmitted infection (STI), which disproportionately affects young people under 25 years. Commonly, more women are offered screening than men. This study obtained the views of general practitioners and practice nurses towards Internet-based screening and assessed levels of support for the development of proactive screening targeting young heterosexual men via the Internet. Methods: Semi-structured telephone interviews with 10 general practitioners and 8 practice nurses, across Central Scotland. Topics covered: experience of screening heterosexual men for chlamydia, views on the use of the Internet as a way to reach young men for chlamydia screening, beliefs about the potential barriers and facilitators to Internet-based screening. Transcripts from audio recordings were analysed with Framework Analysis, using QSR NVivo10. Results: Experiences of chlamydia screening were almost exclusively with women, driven by the nature of consultations and ease of raising sexual health issues with female patients; few practice nurses reported seeing men during consultations. All participants spoke in favour of Internet-based screening for young men. Participants reported ease of access and convenience as potential facilitators of an Internet-based approach but anonymity and confidentiality could be potential barriers and facilitators to the success of an Internet approach to screening. Concerns over practical issues as well as those pertaining to gender and socio-cultural issues were raised. Conclusions: Awareness of key barriers and facilitators, such as confidentiality, practicality and socio-cultural influences, will inform the development of an Internet-based approach to screening. However, this approach may have its limits in terms of being able to tackle wider social and cultural barriers, along with shifts in young people's and health professionals' attitudes towards screening. Nevertheless, employing innovative efforts as part of a multi-faceted approach is required to ensure effective interventions reach the policy agenda

No Neutron Star Companion To The Lowest Mass SDSS White Dwarf

SDSS J091709.55+463821.8 (hereafter J0917+4638) is the lowest surface gravity white dwarf (WD) currently known, with log g = 5.55 +/- 0.05 (M ~ 0.17 M_sun; Kilic et al. 2007a,b). Such low-mass white dwarfs (LMWDs) are believed to originate in binaries that evolve into WD/WD or WD/neutron star (NS) systems. An optical search for J0917+4638's companion showed that it must be a compact object with a mass >= 0.28 M_sun (Kilic 2007b). Here we report on Green Bank Telescope 820 MHz and XMM-Newton X-ray observations of J0917+4638 intended to uncover a potential NS companion to the LMWD. No convincing pulsar signal is detected in our radio data. Our X-ray observation also failed to detect X-ray emission from J0917+4638's companion, while we would have detected any of the millisecond radio pulsars in 47 Tuc. We conclude that the companion is almost certainly another WD.Comment: 4 pages, 1 table; to appear in the Astrophysical Journal Letter

Mixed-Morphology Supernova Remnants in X-rays: Isothermal Plasma in HB21 and Probable Oxygen-Rich Ejecta in CTB 1

(Abridged) We present an analysis of X-ray observations made of the Galactic supernova remnants (SNRs) HB21 (G89.0+4.7) and CTB 1 (G116.9+0.2), two well-known mixed-morphology (MM) SNRs. We find a marked contrast between the X-ray properties of these SNRs: for HB21, the extracted ASCA spectra of the northwest and southeast regions of the X-ray emitting plasma can be fit with a single thermal model with marginally enhanced silicon and sulfur abundances. For both of these regions, the derived column density and temperature are N_H~0.3x10^22 cm^-2 and kT~0.7 keV, respectively. No significant spatial differences in temperature or elemental abundances between the two regions are detected and the X-ray-emitting plasma in both regions is close to ionization equilibrium. Our Chandra spectral analysis of CTB 1 reveals that this source is likely an oxygen-rich SNR with enhanced abundances of oxygen and neon. The extracted ASCA spectra for the southwestern and northeastern regions of CTB 1 cannot be fit with a single thermal component. Based on our fits to these spectra, we derive a column density N_H~0.6x10^22 cm^-2 and a temperature for the soft thermal component of kT_soft~0.28 keV. The hard emission from the southwest may be modeled with either a thermal component (kT_hard~3 keV) or by a power law component (Gamma~2-3) while the hard emission from the northeast may be modeled with a power law component (Gamma~1.4). We have also extracted ASCA GIS spectra of the discrete X-ray source 1WGA J0001.4+6229 which is seen in projection toward CTB 1. These spectra are best fit using a power-law model with a photon index Gamma=2.2^{+0.5}_{-1.2} which is typical for featureless power-law continua produced by rotation-powered pulsars. This source may be a neutron star associated with CTB 1.Comment: 46 pages, 16 figures, accepted for publication in the Astronomical Journa

Tree regeneration and spatial patterning among midtolerant tree species following gap-based harvesting in a temperate hardwood forest

IntroductionField experiments of gap-based harvest systems in temperate northern hardwood forests have provided inconsistent support for the theory that such regeneration approaches can improve regeneration success among increasingly underrepresented tree species intermediate in shade tolerance. We established a field experiment in Wisconsin, USA testing the long-term response of tree regeneration to group selection harvesting that created small (50 m2–D:H 0.32), medium (200 m2—D:H 0.64) and large (380 m2—D:H 0.88) gaps.Materials and methodsLight levels were modeled to test the assumption of resource heterogeneity within and across these gap sizes. Spatial statistics were used to assess whether the point patterns of saplings of several midtolerant tree species (Betula alleghaniensis, Carya cordiformis, Fraxinus spp.) mapped in harvest gaps provided evidence for partitioning across resource gradients 9 years post-harvest. Finally, we measured occurrence and height of all saplings within the harvest gaps to test the effects of gap size and deer exclusion fencing on the density and total height of shade-tolerant and midtolerant tree regeneration.Results and discussionLight levels progressively increased with gap size, varied by position within gaps, and provided significant evidence of resource heterogeneity. The complex light gradients formed both within and across the three gap sizes may partially explain the statistically significant clustering of Fraxinus spp. saplings in gap centers and north and east into the forested edge of medium and large gaps, C. cordiformis on the west sides of forested transitions surrounding large gaps, and B. alleghaniensis in the centers of large gaps. Densities of tolerant and midtolerant saplings were similar in medium and large gaps after nine growing seasons, though tolerant saplings averaged two meters taller across all three gap sizes. Our results show that gap-based silvicultural systems can create resource gradients that are sufficient to regenerate mixtures of species with high to intermediate tolerance of shade. However, prescriptions beyond harvesting and deer exclusion fencing may be necessary for the recruitment of midtolerant species to canopy positions

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

Background: Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. Objectives: To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. Data sources: All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. Review methods: A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. Results: Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from ‘goals and planning’ and ‘identity’ groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. Limitations: There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. Conclusions: Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. Future work: There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity

The Relation Between the Surface Brightness and the Diameter for Galactic Supernova Remnants

In this work, we have constructed a relation between the surface brightness ($\Sigma$) and diameter (D) of Galactic C- and S-type supernova remnants (SNRs). In order to calibrate the $\Sigma$-D dependence, we have carefully examined some intrinsic (e.g. explosion energy) and extrinsic (e.g. density of the ambient medium) properties of the remnants and, taking into account also the distance values given in the literature, we have adopted distances for some of the SNRs which have relatively more reliable distance values. These calibrator SNRs are all C- and S-type SNRs, i.e. F-type SNRs (and S-type SNR Cas A which has an exceptionally high surface brightness) are excluded. The Sigma-D relation has 2 slopes with a turning point at D=36.5 pc: $\Sigma$(at 1 GHz)=8.4$^{+19.5}_{-6.3}$$\times10^{-12}$ D$^{{-5.99}^{+0.38}_{-0.33}}$ Wm$^{-2}$Hz$^{-1}$ster$^{-1}$ (for $\Sigma$$\le3.7\times10^{-21}$ Wm$^{-2}$Hz$^{-1}$ster$^{-1}$ and D$\ge$36.5 pc) and $\Sigma$(at 1 GHz)=2.7$^{+2.1}_{-1.4}$$\times$ 10$^{-17}$ D$^{{-2.47}^{+0.20}_{-0.16}}$ Wm$^{-2}$Hz$^{-1}$ster$^{-1}$ (for $\Sigma$$>3.7\times10^{-21}$ Wm$^{-2}$Hz$^{-1}$ster$^{-1}$ and D$<$36.5 pc). We discussed the theoretical basis for the $\Sigma$-D dependence and particularly the reasons for the change in slope of the relation were stated. Added to this, we have shown the dependence between the radio luminosity and the diameter which seems to have a slope close to zero up to about D=36.5 pc. We have also adopted distance and diameter values for all of the observed Galactic SNRs by examining all the available distance values presented in the literature together with the distances found from our $\Sigma$-D relation.Comment: 45 pages, 2 figures, accepted for publication in Astronomical and Astrophysical Transaction

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)