Are chronic low back pain outcomes improved with co-management of concurrent depression?

OBJECTIVE: To discuss the role of depression in chronic lower back pain and comment on appropriate methods of screening and co-management. DATA SOURCES: The current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches. DATA EXTRACTION: Databases were searched from 1980 to the present (2005). Articles were searched with the key words "depression" and "low back pain". Over three hundred articles were sourced and articles were then selected on their relevance to the chronic spinal pain states that present to manual therapy practitioners. DATA SYNTHESIS: Pain is a subjective awareness of peripheral nociceptive stimulation, projected from the thalamus to the cerebral cortex with each individual's pain experience being mediated by his or her psychological state. Thus a psychological component will often be associated with any painful experience. A number of studies suggest (among other things) that the incidence of depression predicts chronicity in lower back pain syndromes but that chronic lower back pain does not have the reciprocal action to predict depression. CONCLUSION: The aetiology of chronic pain is multifactorial. There is sufficient evidence in the literature to demonstrate a requirement to draw treatment options from many sources in order to achieve a favourable pain relief outcome. The treatment should be multimodal, including mental and emotional support, counseling and herbal advice. While a strong correlation between depression and chronic low back pain can be demonstrated, an apparent paucity of literature that specifically addresses the patient response to chiropractic treatment and concurrent psychotherapy identifies the need for prospective studies of this nature to be undertaken. It is likely that multimodal/multidisciplinary treatment approaches should be encouraged to deal with these chronic lower back pain syndromes

Dynamic Knobs for Responsive Power-Aware Computing

We present PowerDial, a system for dynamically adapting application behavior to execute successfully in the face of load and power fluctuations. PowerDial transforms static configuration parameters into dynamic knobs that the PowerDial control system can manipulate to dynamically trade off the accuracy of the computation in return for reductions in the computational resources that the application requires to produce its results. These reductions translate directly into performance improvements and power savings. Our experimental results show that PowerDial can enable our benchmark applications to execute responsively in the face of power caps that would otherwise significantly impair responsiveness. They also show that PowerDial can significantly reduce the number of machines required to service intermittent load spikes, enabling reductions in power and capital costs.National Science Foundation (U.S.). (Grant Number 0937060)United States. Defense Advanced Research Projects Agency (Grant number FA8750-06-2-0189

High-Fidelity Spacecraft Thermal Modeling: Synthesis of STK, SPENVIS, MATLAB, Simulink, and Thermal Desktop using Model-Based Systems Engineering

Verification and Validation (V&V) by analysis for required spacecraft Heater Wattage (HW) and Radiator Area (RA) is a rigorous, iterative procedure highly dependent on spacecraft areas, surface absorptivity, surface emissivity, orbital position, orbital attitude, and operational heat generation. The Alabama Burst Energetics eXplorer (ABEX) mission adopts a Model-Based Systems Engineering (MBSE) approach to analysis wherein model strengths and weaknesses are considered synergistically and integrated using SysML parametric and structural diagrams to create a System of Models (SoM). In this work, a procedure for comprehensive spacecraft thermal modeling is detailed using MBSE-centric Modeling and Simulation (M&S) practices. The SysML model is used as a foundational data source for all other models, and non-SysML model exports are provided back to the SysML model in useful format. Because the analytical models in Systems Tool Kit (STK), MATLAB, Simulink, Thermal Desktop, and the Space Environment Information System (SPENVIS) are sourcing input data only from the SysML model, V&V for input data pedigree is only required in SysML for the purposes of National Aeronautics and Space Administration (NASA)-STD-7009: Standard for Models & Simulations, saving valuable program schedule time. Common of many thermal analysis approaches, a low-fidelity, isothermal model is first developed in MATLAB to provide environmental calculations and preliminary HW and RA values to a higher-fidelity model, here developed in Simulink. The non-isothermal Simulink model results inform a Thermal Desktop model, which is used as the basis for qualification-level hardware development. In the analytical models, STK simulates spacecraft modes of operation and communication profiles to export transient spacecraft position and velocity state vectors, solar position state vectors, Earth position state vectors, and unit vectors orthogonal to each spacecraft face, among non-thermal data. An orbital model in SPENVIS produces corpuscular radiation integral flux data for the determination of Charged Particle Heating (CPH), and the MATLAB model imports the STK and SPENVIS data. In MATLAB, heat fluxes from direct solar emission, Earth emission, Earth albedo, CPH, and Free Molecular Heating (FMH) are calculated and converted to absorbed heat values; radiation surface reflectivity is calculated using specular, spectral Fresnel relationships accounting for complex, spectral refractive indices of both the spacecraft surface coating material and base layer material, surface coating material thickness, and radiation Angle of Incidence (AOI). The MATLAB model utilizes an isothermal energy balance to output a low-fidelity HW and RA value required to stay above and below component operational temperatures, respectively. In Simulink, component thermal capacitances are distributed in a thermal resistance network with each discrete spacecraft component considered isothermal; absorbed heat and advanced reflectivity calculations are also recalculated per component. An array of values is generated for both HW and RA between zero and twice the value provided by the MATLAB isothermal model to create a matrix of potential HW and RA combinations. The Simulink model determines an operational envelope of viable HW and RA combinations for user-defined heater and radiator locations; acceptable HW and RA combinations are those that result in component temperatures within operational boundaries. The HW and RA combinations at the edges of the Simulink-derived operational envelope are provided to a three-dimensional, geometry-specific Thermal Desktop model wherein high-fidelity HW and RA values can be analyzed specific to mounting considerations. In this SoM progression from MATLAB to Simulink to Thermal Desktop driven by data inputs from STK and SPENVIS with a central source of truth for all models based in SysML, uncertainty and risk regarding thermal control analysis results are systematically mitigated

Sustaining a new model of acute stroke care : A mixed-method process evaluation of the Melbourne Mobile Stroke Unit

Background Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care. Methods Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (AV) (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology (UTAUT), Self Determination Theory (SDT, Intrinsic Motivation), and open-text questions targeting barriers and benefits was administered (June-September 2019). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted. Results There were 135 surveys completed. Identifying that the MSU was beneficial to daily work (β = 0.61), not experiencing pressure/tension about working on the MSU (β = 0.17) and thinking they did well working within the team model (β = 0.17) were significantly associated with wanting to continue working within the MSU model [R2 = 0.76; F(15, 60) = 12.76, P < .001]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from 35 interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, MSU operations and dispatch specificity. Conclusion Important factors affecting the sustainability of the MSU model of stroke care emerged. A cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability

Time course of tinnitus development following noise exposure in mice

Gap‐induced prepulse inhibition of acoustic startle (GPIAS) has been used in rats and mice to study the problem of tinnitus. The current study demonstrates that similar methods can be used to study the temporal development of tinnitus over time in middle‐aged mice. Six‐month‐old mice on a mixed C57Bl6 × 129 background were anesthetized with isoflurane and exposed to unilateral noise (n = 15), or sham exposure for controls (n = 8), for 1 hr (16‐kHz octave band signal, 116‐dB SPL). Tinnitus was tested in eight different sound frequency bands before and at postexposure time points of 1, 3–4, 7, 14, 21, and 30 days and monthly thereafter until 7 months postexposure. Noise‐exposed mice displayed a number of changes in GPIAS consistent with the presence of hyperacusis and tinnitus. Noise exposure was associated with acute tinnitus measured 1 day later at several frequencies at and above the exposure frequency center. Consistent, chronic tinnitus then emerged in the 24‐kHz range. Several time points following noise exposure suggested evidence of hyperacusis, often followed temporally by the development of deficits in GPIAS (reflecting tinnitus). Temporal development of these changes following noise exposure are discussed in the context of the interactions among aging, noise exposure, and the associated neurochemical changes that occur at early stages of auditory processing. © 2012 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91367/1/22827_ftp.pd

Recovering Dietary Information from Extant and Extinct Primates Using Plant Microremains

When reconstructing the diets of primates, researchers often rely on several well established methods, such as direct observation, studies of discarded plant parts, and analysis of macrobotanical remains in fecal matter. Most of these studies can be performed only on living primate groups, however, and the diets of extinct, subfossil, and fossil groups are known only from proxy methods. Plant microremains, tiny plant structures with distinctive morphologies, can record the exact plant foods that an individual consumed. They can be recovered from recently deceased and fossil primate samples, and can also be used to supplement traditional dietary analyses in living groups. Here I briefly introduce plant microremains, provide examples of how they have been successfully used to reconstruct the diets of humans and other species, and describe methods for their application in studies of primate dietary ecology