A study to determine the effectiveness of chiropractic manipulative therapy of the sacroiliac joint and pelvic stabilisation exercises in the management of post-partum lower back pain

This study compared the effectiveness of three different Chiropractic treatment protocols in the treatment of post-partum low back pain. This was done in order to establish whether or not a combined treatment of Chiropractic Manipulative Therapy (CMT) of the sacroiliac joint combined with slow dynamic strengthening exercises to strengthen and stabilise the pelvis is a more effective treatment than CMT of the sacroiliac joint alone, or slow dynamic strengthening exercises in isolation. Thirty participants were used for this study. They were randomly placed into one of three groups namely; group 1, group 2 and group 3. Group 1 received CMT solely to the involved sacroiliac joint. Group 2 received slow dynamic strengthening exercises of gluteus medius, piriformis and psoas muscles. These exercises were designed to strengthen and stabilise the pelvis. Group 3 received a combination of the above two treatments. Six treatments were administered over a period of three weeks with each participant receiving two treatments per week. Prior to the commencement of treatments one, three and six; each participant was objectively measured for forward flexion range of motion using the Modified Schober’s test. The subjective measurements used in this study were the Numerical Pain Rating Scale and the Oswestry Lower Back Pain and Disability Questionnaire, these were also completed prior to first, third and sixth treatments. All the collected data was statistically analysed using the one-way Anova test, the Scheffe Multiple Comparisons test and the Paired-t test. This statistical analysis revealed statistical differences on intra-group analysis, for all the three groups involved, mostly between treatment three and treatment six for both the objective and subjective measurements. On inter-group analysis no statistical differences were found although group three subjective and objective measurements improved by a larger percentage than both group one and group two. It was thus concluded that a combined treatment of CMT and slow dynamic strengthening exercises of gluteus medius, piriformis and psoas muscles was the most effective protocol to use on women with post-partum low back pain.Dr. C.D. Losco Dr. B. Losc

Joint Optimal Design and Operation of Hybrid Energy Storage Systems

The wide range of performance characteristics of storage technologies motivates the use of a hybrid energy storage systems (HESS) that combines the best features of multiple technologies. However, HESS design is complex, in that it involves the choice of storage technologies, the sizing of each storage element, and deciding when to charge and discharge each underlying storage element (the operating strategy.We formulate the problem of jointly optimizing the sizing and the operating strategy of an HESS that can be used for a large class of applications and storage technologies. Instead of a single set of storage element sizes, our approach determines the Pareto-optimal frontier of the sizes of the storage elements along with the corresponding optimal operating strategy. Thus, as long as the performance objective of a storage application (such as an off-grid microgrid) can be expressed as a linear combination of the underlying storage sizes, the optimal vector of storage sizes falls somewhere on this frontier. We present two case studies to illustrate our approach, demonstrating that a single storage technology is sometimes inadequate to meet application requirements, unlike an HESS designed using our approach. We also find simple, near-optimal, and practical operating strategies for these case studies, which allows us to gain several new engineering insights

Proteomic Profiling Identifies Specific Leukemic Stem Cell-Associated Protein Expression Patterns in Pediatric AML Patients

SIMPLE SUMMARY: Acute myeloid leukemia is an aggressive cancer in children and novel therapeutic tools are warranted to improve outcomes and reduce late effects in these patients. In this study, we isolate and explore the protein profiles of leukemic stem cells and normal hematopoietic stem cells from hematologically healthy children. Differences in protein profiles between leukemic and normal hematopoietic stem cells were identified. These results provide an insight into the disrupted biological pathways in childhood acute myeloid leukemia. Moreover, differences in protein profiles may serve as potential targets for future therapies specifically aiming at the disease-propagating leukemic stem cells while omitting the normal hematopoietic stem cells. ABSTRACT: Novel therapeutic tools are warranted to improve outcomes for children with acute myeloid leukemia (AML). Differences in the proteome of leukemic blasts and stem cells (AML-SCs) in AML compared with normal hematopoietic stem cells (HSCs) may facilitate the identification of potential targets for future treatment strategies. In this explorative study, we used mass spectrometry to compare the proteome of AML-SCs and CLEC12A+ blasts from five pediatric AML patients with HSCs and hematopoietic progenitor cells from hematologically healthy, age-matched controls. A total of 456 shared proteins were identified in both leukemic and control samples. Varying protein expression profiles were observed in AML-SCs and leukemic blasts, none having any overall resemblance to healthy counterpart cell populations. Thirty-four proteins were differentially expressed between AML-SCs and HSCs, including the upregulation of HSPE1, SRSF1, and NUP210, and the enrichment of proteins suggestive of protein synthesis perturbations through the downregulation of EIF2 signaling was found. Among others, NUP210 and calreticulin were upregulated in CLEC12A+ blasts compared with HSCs. In conclusion, the observed differences in protein expression between pediatric patients with AML and pediatric controls, in particular when comparing stem cell subsets, encourages the extended exploration of leukemia and AML-SC-specific biomarkers of potential relevance in the development of future therapeutic options in pediatric AML

Pharmacokinetics of oral and intravenous melatonin in healthy volunteers

BACKGROUND: The aim was to investigate the pharmacokinetics of oral and iv melatonin in healthy volunteers. METHODS: The study was performed as a cohort crossover study. The volunteers received either 10 mg oral melatonin or 10 mg intravenous melatonin on two separate study days. Blood samples were collected at different time points following oral administration and short iv infusion, respectively. Plasma melatonin concentrations were determined by RIA technique. Pharmacokinetic analyses were performed by “the method of residuals” and compartmental analysis. The pharmacokinetic variables: k(a), t(1/2 absorption), t(max), C(max), t(1/2 elimination,)AUC(0-∞), and bioavailability were determined for oral melatonin. C(max), t(1/2 elimination), V(d), CL and AUC(0-∞) were determined for intravenous melatonin. RESULTS: Twelve male volunteers completed the study. Baseline melatonin plasma levels did not differ significantly between the study days (P = 0.067). Mean (SD) t(1/2 absorption) of oral melatonin was 6.0 (3.1) min. Mean t(max) was 40.8 (17.8) min with a median (IQR) C(max) of 3550.5 (2500.5–8057.5) pg ml(-1). Mean t(1/2 elimination) was 53.7 (7.0) min. Median absolute bioavailability was 2.5 (1.7–4.7) %. Median C(max) after short iv infusion of melatonin was 389,875.0 (174,775.0–440,362.5) pg ml(-1). Mean t(1/2 elimination) was 39.4 (3.6) min, mean V(d) 1.2 (0.6) l kg(-1) and mean CL 0.0218 (0.0102) l min(-1) kg(-1). CONCLUSIONS: This cohort crossover study estimated pharmacokinetics of oral and iv melatonin, respectively in healthy volunteers. Bioavailability of oral melatonin was only 3 %. TRIAL REGISTRATION: Eudra-CT number: 2013-000205-23 (initial registration 27.03.2013). Clinicaltrials.gov Identifier: NCT01923974 (initial registration 08.08.2013)

Patients' perspectives on quality of care for chronic hand eczema:a qualitative study

BACKGROUND: Hand eczema (HE) has a significant impact on quality of life and work related activities. Little is known about the patients' perspectives on quality of care for HE. OBJECTIVES: To evaluate the patient perspective of the HE care process in a tertiary referral center. METHODS: Qualitative, semi-structured focus groups were carried out and recorded, transcribed and analysed by an inductive-deductive thematic approach. RESULTS: Fifteen patients participated in four focus groups. Time and attention, together with being listened to and understood by the health care professional, were the most important aspects of care for HE mentioned by participants. Other important insights included: Diagnoses, causes and follow-up of HE were not always clear to the participant; more psychosocial support was needed; participants experienced frequent changes in doctors. Information provided by nurses was valuable, but more individualized advice was needed. CONCLUSIONS: In order to better meet the needs of patients, more explanation should be given about the causes of HE and final diagnosis. Besides focusing on the treatment, it is also important to focus on its impact on the patient and options for psychosocial and peer support should be discussed. Furthermore, the specialized nurse as part of integrated care was emphasized. This article is protected by copyright. All rights reserved

Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder:Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial

Abstract Background Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the \u201cThe Unified Protocol for Transdiagnostic Treatment of Emotional Disorders\u201d (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. Methods/design The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6\ua0months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence. Discussion The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect. Trial registration Clinicaltrials.gov NCT02954731 . Registered 25 October 201