Chiropractic treatment of older adults with neck pain with or without headache or dizziness: Analysis of 288 Australian chiropractors' self-reported views

© 2019 The Author(s). Background: Neck pain is a leading cause of individual and societal burden worldwide, affecting an estimated 1 in 5 people aged 70 years and older. The nature and outcomes of chiropractic care for older adults with neck pain, particularly those with co-morbid headaches, remains poorly understood. Therefore, we sought to ascertain: What proportion of Australian chiropractors' caseload comprises older adults with neck pain (with or without headache); How are these conditions treated; What are the reported outcomes? Methods: An online survey examining practitioner and practice characteristics, clinical patient presentations, chiropractic treatment methods and outcomes, and other health service use, was distributed to a random nationally representative sample of 800 Australian chiropractors. Quantitative methods were used to analyze the data. Results: Two hundred eighty-eight chiropractors (response rate = 36%) completed the survey between August and November 2017. Approximately one-third (M 28.5%, SD 14.2) of the chiropractors' patients were older adults (i.e. aged ≥65 years), of which 45.5% (SD 20.6) presented with neck pain and 31.3% (SD 20.3) had co-morbid headache. Chiropractors reported to combine a range of physical and manual therapy treatments, exercises and self-management practices in their care of these patients particularly: manipulation of the thoracic spine (82.0%); activator adjustment of the neck (77.3%); and massage of the neck (76.5%). The average number of visits required to resolve headache symptoms was reported to be highest among those with migraine (M 11.2, SD 8.8). The majority of chiropractors (57.3%) reported a moderate response to treatment in reported dizziness amongst older adults with neck pain. Approximately 82% of older adult patients were estimated to use at least one other health service concurrently to chiropractic care to manage their neck pain. Conclusion: This is the first known study to investigate chiropractic care of older adults living with neck pain. Chiropractors report using well-established conservative techniques to manage neck pain in older adults. Our findings also indicate that this target group of patients may frequently integrate chiropractic care with other health services in order to manage their neck pain. Further research should provide in-depth investigation of older patients' experience and other patient-reported outcomes of chiropractic treatment

High frequency continuous birefringence-induced oscillations in spin-polarized vertical-cavity surface-emitting lasers

Sustained, large amplitude and tunable birefringence-induced oscillations are obtained in a spin-vertical cavity surface-emitting laser (spin-VCSEL). Experimental evidence is provided using a spin-VCSEL operating at 1300 nm, under continuous-wave optical pumping and at room temperature. Numerical and stability analyses are performed to interpret the experiments and to identify the combined effects of pump ellipticity, spin relaxation rate, and cavity birefringence. Importantly, the frequency of the induced oscillations is determined by the device’s birefringence rate, which can be tuned to very large values. This opens the path for ultrafast spin-lasers operating at record frequencies exceeding those possible in traditional semiconductor lasers and with ample expected impact in disparate disciplines (e.g., datacomms, spectroscopy)

International Lessons in New Methods for Grading and Integrating Cost Effectiveness Evidence into Clinical Practice Guidelines

Economic evidence is influential in health technology assessment world-wide. Clinical Practice Guidelines (CPG) can enable economists to include economic information on health care provision. Application of economic evidence in CPGs, and its integration into clinical practice and national decision making is hampered by objections from professions, paucity of economic evidence or lack of policy commitment. The use of state-of-art economic methodologies will improve this. Economic evidence can be graded by 'checklists' to establish the best evidence for decision making given methodological rigor. New economic evaluation checklists, Multi-Criteria Decision Analyses (MCDA) and other decision criteria enable health economists to impact on decision making world-wide. We analyse the methodologies for integrating economic evidence into CPG agencies globally, including the Agency of Health Research and Quality (AHRQ) in the USA, National Health and Medical Research Council (NHMRC) and Australian political reforms. The Guidelines and Economists Network International (GENI) Board members from Australia, UK, Canada and Denmark presented the findings at the conference of the International Health Economists Association (IHEA) and we report conclusions and developments since. The Consolidated Guidelines for the Reporting of Economic Evaluations (CHEERS) 24 item check list can be used by AHRQ, NHMRC, other CPG and health organisations, in conjunction with the Drummond ten-point check list and a questionnaire that scores that checklist for grading studies, when assessing economic evidence. Cost-effectiveness Analysis (CEA) thresholds, opportunity cost and willingness-to-pay (WTP) are crucial issues for decision rules in CEA generally, including end-of-life therapies. Limitations of inter-rater reliability in checklists can be addressed by including more than one assessor to reach a consensus, especially when impacting on treatment decisions. We identify priority areas to generate economic evidence for CPGs by NHMRC, AHRQ, and other agencies. The evidence may cover demand for care issues such as involved time, logistics, innovation price, price sensitivity, substitutes and complements, WTP, absenteeism and presentism. Supply issues may include economies of scale, efficiency changes, and return on investment. Involved equity and efficiency measures may include cost-of-illness, disease burden, quality-of-life, budget impact, cost-effective ratios, net benefits and disparities in access and outcomes.. Priority setting remains essential and trade-off decisions between policy criteria can be based on MCDA, both in evidence based clinical medicine and in health planning

Lessons from crossing symmetry at large N

20 pages, v2: Assumptions stated more clearly, version published in JHEPWe consider the four-point correlator of the stress tensor multiplet in N=4 SYM. We construct all solutions consistent with crossing symmetry in the limit of large central charge c ~ N^2 and large g^2 N. While we find an infinite tower of solutions, we argue most of them are suppressed by an extra scale \Delta_{gap} and are consistent with the upper bounds for the scaling dimension of unprotected operators observed in the numerical superconformal bootstrap at large central charge. These solutions organize as a double expansion in 1/c and 1/\Delta_{gap}. Our solutions are valid to leading order in 1/c and to all orders in 1/\Delta_{gap} and reproduce, in particular, instanton corrections previously found. Furthermore, we find a connection between such upper bounds and positivity constraints arising from causality in flat space. Finally, we show that certain relations derived from causality constraints for scattering in AdS follow from crossing symmetry.Peer reviewe

Graceful degradation under noise on brain inspired robot controllers

How can we build robot controllers that are able to work under harsh conditions, but without experiencing catastrophic failures? As seen on the recent Fukushima’s nuclear disaster, standard robots break down when exposed to high radiation environments. Here we present the results from two arrangements of Spiking Neural Networks, based on the Liquid State Machine (LSM) framework, that were able to gracefully degrade under the effects of a noisy current injected directly into each simulated neuron. These noisy currents could be seen, in a simplified way, as the consequences of exposition to non-destructive radiation. The results show that not only can the systems withstand noise, but one of the configurations, the Modular Parallel LSM, actually improved its results, in a certain range, when the noise levels were increased. Also, the robot controllers implemented in this work are suitable to run on a modern, power efficient neuromorphic hardware such as SpiNNaker

Numerical properties of staggered quarks with a taste-dependent mass term

The numerical properties of staggered Dirac operators with a taste-dependent mass term proposed by Adams [1,2] and by Hoelbling [3] are compared with those of ordinary staggered and Wilson Dirac operators. In the free limit and on (quenched) interacting configurations, we consider their topological properties, their spectrum, and the resulting pion mass. Although we also consider the spectral structure, topological properties, locality, and computational cost of an overlap operator with a staggered kernel, we call attention to the possibility of using the Adams and Hoelbling operators without the overlap construction. In particular, the Hoelbling operator could be used to simulate two degenerate flavors without additive mass renormalization, and thus without fine-tuning in the chiral limit.Comment: 14 pages, 9 figures. V2: published version; important note added regarding Hoelbling fermions, otherwise minor change

Universality and exactness of Schrodinger geometries in string and M-theory

We propose an organizing principle for classifying and constructing Schrodinger-invariant solutions within string theory and M-theory, based on the idea that such solutions represent nonlinear completions of linearized vector and graviton Kaluza-Klein excitations of AdS compactifications. A crucial simplification, derived from the symmetry of AdS, is that the nonlinearities appear only quadratically. Accordingly, every AdS vacuum admits infinite families of Schrodinger deformations parameterized by the dynamical exponent z. We exhibit the ease of finding these solutions by presenting three new constructions: two from M5 branes, both wrapped and extended, and one from the D1-D5 (and S-dual F1-NS5) system. From the boundary perspective, perturbing a CFT by a null vector operator can lead to nonzero beta-functions for spin-2 operators; however, symmetry restricts them to be at most quadratic in couplings. This point of view also allows us to easily prove nonrenormalization theorems: for any Sch(z) solution of two-derivative supergravity constructed in the above manner, z is uncorrected to all orders in higher derivative corrections if the deforming KK mode lies in a short multiplet of an AdS supergroup. Furthermore, we find infinite classes of 1/4 BPS solutions with 4-,5- and 7-dimensional Schrodinger symmetry that are exact.Comment: 31 pages, plus appendices; v2, minor corrections, added refs, slight change in interpretation in section 2.3, new Schrodinger and Lifshitz solutions included; v3, clarifications in sections 2 and 3 regarding existence of solutions and multi-trace operator

Defining the key wintering habitats in the Sahel for declining African-Eurasian migrants using expert assessment

SummaryThe Sahel in West Africa is a major wintering area for many western Palearctic migrants. The breeding populations of many of these have declined over the past 50 years. However, there have been few intensive field studies on migrant ecology in the Sahel and these were generally within a very restricted area. Consequently our knowledge of the distribution of species within this extensive area and the habitat associations of these species is limited. Understanding these habitat associations is essential for the effective conservation management of populations. We brought together a group of experts and consulted a wider group by email to assess the main Sahelian habitat types used by 68 African-Eurasian migrant bird species. Those species that showed strongest declines during 1970–1990 were associated with more open habitats than those newly declining during 1990–2000, when declining species were associated with habitats with more shrubs and trees. Populations of species that winter in the Sahel are generally stable or increasing now as rainfall has increased and is now near the long-term average for the Sahel. Those which use the Sahel only as a staging area are, in many cases, in rapid decline at present.We would like to thank Andy Clements, Paul Donald, Lincoln Fishpool and Mike Mortimore for contributing to the workshop and Peter Jones, Ian Newton, Volker Salewski, Tim Wacher, Eddy Wymenga and Leo Zwarts for useful comments by email on draft habitat importance scores. This study was funded by the Newton Trust and the Cambridge Conservation Initiative Collaborative Fund, supported by Arcadia. WJS is funded by Arcadia.This is the accepted manuscript of a paper published in Bird Conservation International, Volume 24, Issue 04, December 2014, pp 477-491, DOI: http://dx.doi.org/10.1017/S0959270913000531, Published online: 24 February 201

α-Syntrophin Modulates Myogenin Expression in Differentiating Myoblasts

α-Syntrophin is a scaffolding protein linking signaling proteins to the sarcolemmal dystrophin complex in mature muscle. However, α-syntrophin is also expressed in differentiating myoblasts during the early stages of muscle differentiation. In this study, we examined the relationship between the expression of α-syntrophin and myogenin, a key muscle regulatory factor.The absence of α-syntrophin leads to reduced and delayed myogenin expression. This conclusion is based on experiments using muscle cells isolated from α-syntrophin null mice, muscle regeneration studies in α-syntrophin null mice, experiments in Sol8 cells (a cell line that expresses only low levels of α-syntrophin) and siRNA studies in differentiating C2 cells. In primary cultured myocytes isolated from α-syntrophin null mice, the level of myogenin was less than 50% that from wild type myocytes (p<0.005) 40 h after differentiation induction. In regenerating muscle, the expression of myogenin in the α-syntrophin null muscle was reduced to approximately 25% that of wild type muscle (p<0.005). Conversely, myogenin expression is enhanced in primary cultures of myoblasts isolated from a transgenic mouse over-expressing α-syntrophin and in Sol8 cells transfected with a vector to over-express α-syntrophin. Moreover, we find that myogenin mRNA is reduced in the absence of α-syntrophin and increased by α-syntrophin over-expression. Immunofluorescence microscopy shows that α-syntrophin is localized to the nuclei of differentiating myoblasts. Finally, immunoprecipitation experiments demonstrate that α-syntrophin associates with Mixed-Lineage Leukemia 5, a regulator of myogenin expression.We conclude that α-syntrophin plays an important role in regulating myogenesis by modulating myogenin expression