Injection therapies for Achilles tendinopathy

Background: Achilles tendinopathy is a common condition, often with significant functional consequences. As a wide range of injection treatments are available, a review of randomised trials evaluating injection therapies to help inform treatment decisions is warranted. Objectives: To assess the effects (benefits and harms) of injection therapies for people with Achilles tendinopathy. Search methods: We searched the following databases up to 20 April 2015: the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and SPORTDiscus. We also searched trial registers (29 May 2014) and reference lists of articles to identify additional studies. Selection criteria: We included randomised and quasi-randomised controlled trials evaluating injection therapies in adults with an investigator-reported diagnosis of Achilles tendinopathy. We accepted comparison arms of placebo (sham) or no injection control, or other active treatment (such as physiotherapy, pharmaceuticals or surgery). Our primary outcomes were function, using measures such as the VISA-A (Victorian Institute of Sport Assessment-Achilles questionnaire), and adverse events. Data collection and analysis: Two review authors independently extracted data from the included studies. We assessed treatment effects using mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables and risk ratios (RRs) and 95% CIs for dichotomous variables. For follow-up data, we defined short-term as up to six weeks, medium-term as up to three months and longer-term as data beyond three months. We performed meta-analysis where appropriate. Main results: We included 18 studies (732 participants). Seven trials exclusively studied athletic populations. The mean ages of the participants in the individual trials ranged from 20 years to 50 years. Fifteen trials compared an injection therapy with a placebo injection or no injection control, four trials compared an injection therapy with active treatment, and one compared two different concentrations of the same injection. Thus no trials compared different injection therapies. Two studies had three trial arms and we included them twice in two different categories. Within these categories, we further subdivided injection therapies by mode of action (injury-causing versus direct repair agents). The risk of bias was unclear (due to poor reporting) or high in six trials published between 1987 and 1994. Improved methodology and reporting for the subsequent trials published between 2004 and 2013 meant that these were at less risk of bias. Given the very low quality evidence available from each of four small trials comparing different combinations of injection therapy versus active treatment and the single trial comparing two doses of one injection therapy, only the results of the first comparison (injection therapy versus control) are presented. There is low quality evidence of a lack of significant or clinically important differences in VISA-A scores (0 to 100: best function) between injection therapy and control groups at six weeks (MD 0.79, 95% CI -4.56 to 6.14; 200 participants, five trials), three months (MD -0.94, 95% CI -6.34 to 4.46; 189 participants, five trials) or between six and 12 months (MD 0.14, 95% CI -6.54 to 6.82; 132 participants, three trials). Very low quality evidence from 13 trials showed little difference between the two groups in adverse events (14/243 versus 12/206; RR 0.97, 95% CI 0.50 to 1.89), most of which were minor and short-lasting. The only major adverse event in the injection therapy group was an Achilles tendon rupture, which happened in a trial testing corticosteroid injections. There was very low quality evidence in favour of the injection therapy group in short-term (under three months) pain (219 participants, seven trials) and in the return to sports (335 participants, seven trials). There was very low quality evidence indicating little difference between groups in patient satisfaction with treatment (152 participants, four trials). There was insufficient evidence to conclude on subgroup differences based on mode of action given that only two trials tested injury-causing agents and the clear heterogeneity of the other 13 trials, which tested seven different therapies that act directly on the repair pathway. Authors' conclusions: There is insufficient evidence from randomised controlled trials to draw conclusions on the use, or to support the routine use, of injection therapies for treating Achilles tendinopathy. This review has highlighted a need for definitive research in the area of injection therapies for Achilles tendinopathy, including in older non-athletic populations. This review has shown that there is a consensus in the literature that placebo-controlled trials are considered the most appropriate trial design

Late Holocene climate reorganisation and the North American Monsoon

The North America Monsoon (NAM) provides the majority of rainfall for central and northern Mexico as well as parts of the south west USA. The controls over the strength of the NAM in a given year are complex, and include both Pacific and Atlantic systems. We present here an annually resolved proxy reconstruction of NAM rainfall variability over the last ~6ka, from an inwash record from the Laguna de Juanacatlán, Mexico. This high resolution, exceptionally well dated record allows changes in the NAM through the latter half of the Holocene to be investigated in both time and space domains, improving our understanding of the controls on the system. Our analysis shows a shift in conditions between c. 4 and 3 ka BP, after which clear ENSO/PDO type forcing patterns are evident

Lessons from Laparoscopic Liver Surgery: A Nine-Year Case Series

Objective. This series describes a developing experience in laparoscopic liver surgery presenting results from 40 procedures including right hemihepatectomy, left lateral lobectomy, and microwave ablation therapy. Methods. Forty patients undergoing laparoscopic liver surgery between September 1997 and November 2006 were included. The data set includes: operative procedure and duration, intraoperative blood loss, conversion to open operation rates, length of hospital stay, complications, mortality, histology of lesions/resection margins, and disease recurrence. Results. Mean age of patient: 59 years, 17/40 male, 23/40 female, 23/40 of lesions were benign, and 17/40 malignant. Operations included: laparoscopic anatomical resections n = 15, nonanatomical resections n = 11, microwave ablations n = 8 and deroofing of cysts n = 7. Median anaesthetic time: 120 minutes (range 40–240), mean blood loss 78 mL and 1/40 conversions to open. Median resection margins were 10 mm (range 1–14) and median length of stay 3 days (range 1–10). Operative and 30-day mortality were zero with no local disease recurrence. Conclusion. Laparoscopic liver surgery appears safe and effective and is associated with reduced hospital stay. Larger studies are required to confirm it is oncologically sound

Near-Infrared Galaxy Counts to J and K ~ 24 as a Function of Image Size

We have used the Keck 10m telescope to count objects as a function of image size in 2 high galactic latitude fields covering 1.5 arcmin^2 and reaching 50% completeness at K=24 and J=24.5 for stellar sources. Counts extend ~1 mag deeper in K than surveys with other telescopes; complement Keck surveys providing counts at comparable or shallower depths but not utilizing image structure; and extend by several magnitudes the J band counts from other surveys. We find the surface-density of objects at K=23 to be higher than previously found (~500,000/mag/deg^2), but at K<22 to be consistent with most other surveys in amplitude and slope (~0.36). J band counts have similar slope. J and K counts are in excess of our empirical no-evolution models for an open universe, and a factor of 2 higher than mild-evolution models at J and K ~ 23. The slope of the model counts is insensitive to geometry even in the near-infrared because the counts are dominated by low-luminosity (<0.1L*) objects at modest redshift (z<1) with small apparent sizes (r05<0.4", i.e. <4 kpc). The observed counts rise most steeply for these smaller objects, which dominate fainter than K=22.3 and J=23.3. However, the greatest excess relative to no-evolution models occurs for the apparently larger objects (median J-K~1.5). The size and colors of such objects correspond equally well to luminous (>0.1L*), galaxies at 1<z<4, or progressively more diffuse, low-luminosity (0.001-0.1L*) galaxies at z<1. We rule out the excess is from very low luminosity (<0.0001L*) red galaxies at z<0.25. There is a deficit of galaxies with red J-K colors corresponding to luminous, early-type galaxies at 1<z<3. Assuming the deficit is due to their appearance as blue galaxies, they account only for 10-30% of the excess of large, blue galaxies. [abridged]Comment: accepted for publication in ApJ; 34 pages text, 9 tables, 10 figures (embedded); full resolution figures available at http://www.astro.wisc.edu/~mab/publications/pub.htm

Developing an intervention to facilitate family communication about inherited genetic conditions, and training genetic counsellors in its delivery.

Many families experience difficulty in talking about an inherited genetic condition that affects one or more of them. There have now been a number of studies identifying the issues in detail, however few have developed interventions to assist families. The SPRinG collaborative have used the UK Medical Research Council's guidance on Developing and Evaluating Complex Interventions, to work with families and genetic counsellors (GCs) to co-design a psycho-educational intervention to facilitate family communication and promote better coping and adaptation to living with an inherited genetic condition for parents and their children (<18 years). The intervention is modelled on multi-family discussion groups (MFDGs) used in psychiatric settings. The MFDG was developed and tested over three phases. First focus groups with parents, young people, children and health professionals discussed whether MFDG was acceptable and proposed a suitable design. Using evidence and focus group data, the intervention and a training manual were developed and three GCs were trained in its delivery. Finally, a prototype MFDG was led by a family therapist and co-facilitated by the three GCs. Data analysis showed that families attending the focus groups and intervention thought MFDG highly beneficial, and the pilot sessions had a significant impact on their family' functioning. We also demonstrated that it is possible to train GCs to deliver the MFDG intervention. Further studies are now required to test the feasibility of undertaking a definitive randomised controlled trial to evaluate its effectiveness in improving family outcomes before implementing into genetic counselling practice.The National Institute of Health Research funded the study but any views expressed do not necessarily reflect those of the Authority. Funded by NIHR reference number: RP-DG-1211-10015

Magnetic Cycles in a Convective Dynamo Simulation of a Young Solar-type Star

Young solar-type stars rotate rapidly and many are magnetically active; some undergo magnetic cycles similar to the 22-year solar activity cycle. We conduct simulations of dynamo action in rapidly rotating suns with the 3D MHD anelastic spherical harmonic (ASH) code to explore dynamo action achieved in the convective envelope of a solar-type star rotating at 5 times the current solar rotation rate. Striking global-scale magnetic wreaths appear in the midst of the turbulent convection zone and show rich time-dependence. The dynamo exhibits cyclic activity and undergoes quasi-periodic polarity reversals where both the global-scale poloidal and toroidal fields change in sense on a roughly 1500 day time scale. These magnetic activity patterns emerge spontaneously from the turbulent flow and are more organized temporally and spatially than those realized in our previous simulations of the solar dynamo. We assess in detail the competing processes of magnetic field creation and destruction within our simulations that contribute to the global-scale reversals. We find that the mean toroidal fields are built primarily through an $\Omega$-effect, while the mean poloidal fields are built by turbulent correlations which are not necessarily well represented by a simple $\alpha$-effect. During a reversal the magnetic wreaths propagate towards the polar regions, and this appears to arise from a poleward propagating dynamo wave. The primary response in the convective flows involves the axisymmetric differential rotation which shows variations associated with the poleward propagating magnetic wreaths. In the Sun, similar patterns are observed in the poleward branch of the torsional oscillations, and these may represent poleward propagating magnetic fields deep below the solar surface. [abridged]Comment: 20 pages, 14 figures, emulateapj format; accepted for publication in ApJ. Expanded and published version of sections 5-6 from http://arxiv.org/abs/0906.240

Affecting Effects on Affect: The Impact of Protocol Permutations on Affective Responses to Sprint Interval Exercise; A Systematic Review and Meta-Analysis of Pooled Individual Participant Data

Responses to sprint interval exercise (SIE) are hypothesized to be perceived as unpleasant, but SIE protocols are diverse, and moderating effects of various SIE protocol parameters on affective responses are unknown. We performed a systematic search to identify studies (up to 01/05/2021) measuring affective valence using the Feeling Scale during acute SIE in healthy adults. Thirteen studies involving 18 unique trials and 316 unique participant (142 women and 174 men) affective responses to SIE were eligible for inclusion. We received individual participant data for all participants from all studies. All available end-of-sprint affect scores from each trial were combined in a linear mixed model with sprint duration, mode, intensity, recovery duration, familiarization and baseline affect included as covariates. Affective valence decreased significantly and proportionally with each additional sprint repetition, but this effect was modified by sprint duration: affect decreased more during 30 s (0.84 units/sprint; 95% CI: 0.74–0.93) and 15–20 s sprints (1.02 units/sprint; 95% CI: 0.93–1.10) compared with 5–6 s sprints (0.20 units/sprint; 95% CI: 0.18–0.22) (both p < 0.0001). Although the difference between 15–20 s and 30 s sprints was also significant (p = 0.02), the effect size was trivial (d = −0.12). We observed significant but trivial effects of mode, sprint intensity and pre-trial familiarization, whilst there was no significant effect of recovery duration. We conclude that affective valence declines during SIE, but the magnitude of the decrease for an overall SIE session strongly depends on the number and duration of sprints. This information can be applied by researchers to design SIE protocols that are less likely to be perceived as unpleasant in studies of real-world effectiveness

Emission Features and Source Counts of Galaxies in Mid-Infrared

In this work we incorporate the newest ISO results on the mid-infrared spectral-energy-distributions (MIR SEDs) of galaxies into models for the number counts and redshift distributions of MIR surveys. A three-component model, with empirically determined MIR SED templates of (1) a cirrus/PDR component (2) a starburst component and (3) an AGN component, is developed for infrared (3--120\micron) SEDs of galaxies. The model includes a complete IRAS 25\micron selected sample of 1406 local galaxies ($z \leq 0.1$; Shupe et al. 1998a). Results based on these 1406 spectra show that the MIR emission features cause significant effects on the redshift dependence of the K-corrections for fluxes in the WIRE 25\micron band and ISOCAM 15\micron band. This in turn will affect deep counts and redshift distributions in these two bands, as shown by the predictions of two evolution models (a luminosity evolution model with $L\propto (1+z)^3$ and a density evolution model with $\rho\propto (1+z)^4$). The dips-and-bumps on curves of MIR number counts, caused by the emission features, should be useful indicators of evolution mode. The strong emission features at $\sim 6$--8\micron will help the detections of relatively high redshift ($z\sim 2$) galaxies in MIR surveys. On the other hand, determinations of the evolutionary rate based on the slope of source counts, and studies on the large scale structures using the redshift distribution of MIR sources, will have to treat the effects of the MIR emission features carefully. We have also estimated a 15\micron local luminosity function from the predicted 15\micron fluxes of the 1406 galaxies using the bivariate (15\micron vs. 25\micron luminosities) method. This luminosity function will improve our understanding of the ISOCAM 15\micron surveys.Comment: 24 pages, 14 EPS figures. Accepted by Ap

The APOKASC Catalog: An Asteroseismic and Spectroscopic Joint Survey of Targets in the Kepler Fields

We present the first APOKASC catalog of spectroscopic and asteroseismic properties of 1916 red giants observed in the Kepler fields. The spectroscopic parameters provided from the Apache Point Observatory Galactic Evolution Experiment project are complemented with asteroseismic surface gravities, masses, radii, and mean densities determined by members of the Kepler Asteroseismology Science Consortium. We assess both random and systematic sources of error and include a discussion of sample selection for giants in the Kepler fields. Total uncertainties in the main catalog properties are of order 80 K in Teff , 0.06 dex in [M/H], 0.014 dex in log g, and 12% and 5% in mass and radius, respectively; these reflect a combination of systematic and random errors. Asteroseismic surface gravities are substantially more precise and accurate than spectroscopic ones, and we find good agreement between their mean values and the calibrated spectroscopic surface gravities. There are, however, systematic underlying trends with Teff and log g. Our effective temperature scale is between 0-200 K cooler than that expected from the Infrared Flux Method, depending on the adopted extinction map, which provides evidence for a lower value on average than that inferred for the Kepler Input Catalog (KIC). We find a reasonable correspondence between the photometric KIC and spectroscopic APOKASC metallicity scales, with increased dispersion in KIC metallicities as the absolute metal abundance decreases, and offsets in Teff and log g consistent with those derived in the literature. We present mean fitting relations between APOKASC and KIC observables and discuss future prospects, strengths, and limitations of the catalog data.Comment: 49 pages. ApJSupp, in press. Full machine-readable ascii files available under ancillary data. Categories: Kepler targets, asteroseismology, large spectroscopic survey