Effectiveness of transcranial direct current stimulation alone or preceding cognitive-behavioral management for chronic low back pain: a sham-controlled, double blinded randomized controlled trial

Objective To evaluate the effectiveness of transcranial direct current stimulation alone and in combination with cognitive behavioural management in patients with non-specific chronic low back pain. Design Double blind parallel group randomised controlled trial with six months’ follow-up conducted May 2011-March 2013. Participants, physiotherapists, assessors, and analyses were blinded to group allocation. Setting Interdisciplinary chronic pain centre. Participants 135 participants with non-specific chronic low back pain >12 weeks were recruited from 225 patients assessed for eligibility. Intervention Participants were randomised to receive anodal (20 minutes to motor cortex at 2 mA) or sham transcranial direct current stimulation (identical electrode position, stimulator switched off after 30 seconds) for five consecutive days immediately before cognitive behavioural management (four week multidisciplinary programme of 80 hours). Main outcomes measures Two primary outcome measures of pain intensity (0-100 visual analogue scale) and disability (Oswestry disability index) were evaluated at two primary endpoints after stimulation and after cognitive behavioural management. Results Analyses of covariance with baseline values (pain or disability) as covariates showed that transcranial direct current stimulation was ineffective for the reduction of pain (difference between groups on visual analogue scale 1 mm (99% confidence interval −8.69 mm to 6.3 mm; P=0.68)) and disability (difference between groups 1 point (−1.73 to 1.98; P=0.86)) and did not influence the outcome of cognitive behavioural management (difference between group 3 mm (−10.32 mm to 6.73 mm); P=0.58; difference between groups on Oswestry disability index 0 point (−2.45 to 2.62); P=0.92). The stimulation was well tolerated with minimal transitory side effects. Conclusions This results of this trial on the effectiveness of transcranial direct current stimulation for the reduction of pain and disability do not support its clinical use for managing non-specific chronic low back pain. Trial registration Current controlled trials ISRCTN89874874

ALMA Observations of the Physical and Chemical Conditions in Centaurus A

Centaurus A, with its gas-rich elliptical host galaxy, NGC 5128, is the nearest radio galaxy at a distance of 3.8 Mpc. Its proximity allows us to study the interaction between an active galactic nucleus, radio jets, and molecular gas in great detail. We present ALMA observations of low J transitions of three CO isotopologues, HCN, HCO$^{+}$, HNC, CN, and CCH toward the inner projected 500 pc of NGC 5128. Our observations resolve physical sizes down to 40 pc. By observing multiple chemical probes, we determine the physical and chemical conditions of the nuclear interstellar medium of NGC 5128. This region contains molecular arms associated with the dust lanes and a circumnuclear disk (CND) interior to the molecular arms. The CND is approximately 400 pc by 200 pc and appears to be chemically distinct from the molecular arms. It is dominated by dense gas tracers while the molecular arms are dominated by $^{12}$CO and its rare isotopologues. The CND has a higher temperature, elevated CN/HCN and HCN/HNC intensity ratios, and much weaker $^{13}$CO and C$^{18}$O emission than the molecular arms. This suggests an influence from the AGN on the CND molecular gas. There is also absorption against the AGN with a low velocity complex near the systemic velocity and a high velocity complex shifted by about 60 km s$^{-1}$. We find similar chemical properties between the CND in emission and both the low and high velocity absorption complexes implying that both likely originate from the CND. If the HV complex does originate in the CND, then that gas would correspond to gas falling toward the supermassive black hole

Parents and GPs’ understandings and beliefs about food allergy testing in children with eczema:qualitative interview study within the Trial of Eczema allergy Screening Tests (TEST) feasibility trial

Aim To explore parent and general practitioner (GP) understanding and beliefs about food allergy testing for children with eczema.Design and setting Qualitative interview study in UK primary care within the Trial of Eczema allergy Screening Tests feasibility trial.Participants Semi-structured interviews with parents of children with eczema taking part in the feasibility study and GPs at practices hosting the study.Results 21 parents and 11 GPs were interviewed. Parents discussed a range of potential causes for eczema, including a role for food allergy. They believed allergy testing to be beneficial as it could potentially identify a cure or help reduce symptoms and they found negative tests reassuring, suggesting to them that no dietary changes were needed. GPs reported limited experience and uncertainty regarding food allergy in children with eczema. While some GPs believed referral for allergy testing could be appropriate, most were unclear about its utility. They thought it should be reserved for children with severe eczema or complex problems but wanted more information to advise parents and help guide decision making.Conclusions Parents’ motivations for allergy testing are driven by the desire to improve their child’s condition and exclude food allergy as a possible cause of symptoms. GPs are uncertain about the role of allergy testing and want more information about its usefulness to support parents and help inform decision making.Trial registration number ISRCTN15397185

SMA CO(J=6-5) and 435 micron interferometric imaging of the nuclear region of Arp 220

We have used the Submillimeter Array (SMA) to make the first interferometric observations (beam size ~1") of the 12CO J=6-5 line and 435 micron (690 GHz) continuum emission toward the central region of the nearby ULIRG Arp 220. These observations resolve the eastern and western nuclei from each other, in both the molecular line and dust continuum emission. At 435 micron, the peak intensity of the western nucleus is stronger than the eastern nucleus, and the difference in peak intensities is less than at longer wavelengths. Fitting a simple model to the dust emission observed between 1.3 mm and 435 micron suggests that dust emissivity power law index in the western nucleus is near unity and steeper in the eastern nucleus, about 2, and that the dust emission is optically thick at the shorter wavelength. Comparison with single dish measurements indicate that the interferometer observations are missing ~60% of the dust emission, most likely from a spatially extended component to which these observations are not sensitive. The 12CO J=6-5 line observations clearly resolve kinematically the two nuclei. The distribution and kinematics of the 12CO J=6-5 line appear to be very similar to lower J CO lies observed at similar resolution. Analysis of multiple 12CO line intensities indicates that the molecular gas in both nuclei have similar excitation conditions, although the western nucleus is warmer and denser. The excitation conditions are similar to those found in other extreme environments, including M82, Mrk 231, and BR 1202-0725. Simultaneous lower resolution observations of the 12CO, 13CO, and C18O J=2-1 lines show that the 13CO and C18O lines have similar intensities, which suggests that both of these lines are optically thick, or possibly that extreme high mass star formation has produced in an overabundance of C18O.Comment: 13 pages (emulateapj), 10 figures, Accepted for publication in Ap

Global gene expression analysis of human erythroid progenitors

This article is available open access through the publisher’s website. Copyright @ 2011 American Society of Hematology. This article has an erratum: http://bloodjournal.hematologylibrary.org/content/118/26/6993.3.Understanding the pattern of gene expression during erythropoiesis is crucial for a synthesis of erythroid developmental biology. Here, we isolated 4 distinct populations at successive erythropoietin-dependent stages of erythropoiesis, including the terminal, pyknotic stage. The transcriptome was determined using Affymetrix arrays. First, we demonstrated the importance of using defined cell populations to identify lineage and temporally specific patterns of gene expression. Cells sorted by surface expression profile not only express significantly fewer genes than unsorted cells but also demonstrate significantly greater differences in the expression levels of particular genes between stages than unsorted cells. Second, using standard software, we identified more than 1000 transcripts not previously observed to be differentially expressed during erythroid maturation, 13 of which are highly significantly terminally regulated, including RFXAP and SMARCA4. Third, using matched filtering, we identified 12 transcripts not previously reported to be continuously up-regulated in maturing human primary erythroblasts. Finally, using transcription factor binding site analysis, we identified potential transcription factors that may regulate gene expression during terminal erythropoiesis. Our stringent lists of differentially regulated and continuously expressed transcripts containing many genes with undiscovered functions in erythroblasts are a resource for future functional studies of erythropoiesis. Our Human Erythroid Maturation database is available at https://cellline.molbiol.ox.ac.uk/eryth/index.html.National Health Service Blood and Transplant, National Institute for Health Research Biomedical Research Center Program, and National Institute for Health Research

A Detection of [CII] line emission in the z=4.7 QSO BR1202-0725

We present ~3'' resolution imaging of the z=4.7 QSO BR1202-0725 at 900 micron from the Submillimeter Array. The two submillimeter continuum components are clearly resolved from each other, and the positions are consistent with previous lower frequency images. In addition, we detect [CII] line emission from the northern component. The ratio of [CII] to far-infrared luminosity is 0.04% for the northern component, and an upper limit of < 0.03% is obtained for the southern component. These ratios are similar to the low values found in local ultraluminous galaxies, indicating that the excitation conditions are different from those found in local field galaxies. X-ray emission is detected by Chandra from the southern component at L$_{0.5-2keV}=3\times10^{45}$~erg~s$^{-1}$, and detected at 99.6% confidence from the northern component at L$_{0.5-2keV}\sim3\times10^{44}$erg~s$^{-1}$, supporting the idea that BR1202-0725 is a pair of interacting galaxies at z=4.7 that each harbor an active nucleus.Comment: 8 pages, ApJL accepte

Synergistic malaria vaccine combinations identified by systematic antigen screening.

A highly effective vaccine would be a valuable weapon in the drive toward malaria elimination. No such vaccine currently exists, and only a handful of the hundreds of potential candidates in the parasite genome have been evaluated. In this study, we systematically evaluated 29 antigens likely to be involved in erythrocyte invasion, an essential developmental stage during which the malaria parasite is vulnerable to antibody-mediated inhibition. Testing antigens alone and in combination identified several strain-transcending targets that had synergistic combinatorial effects in vitro, while studies in an endemic population revealed that combinations of the same antigens were associated with protection from febrile malaria. Video microscopy established that the most effective combinations targeted multiple discrete stages of invasion, suggesting a mechanistic explanation for synergy. Overall, this study both identifies specific antigen combinations for high-priority clinical testing and establishes a generalizable approach that is more likely to produce effective vaccines

Parents and GPs' understandings and beliefs about food allergy testing in children with eczema: Qualitative interview study within the Trial of Eczema allergy Screening Tests (TEST) feasibility trial

Aim To explore parent and general practitioner (GP) understanding and beliefs about food allergy testing for children with eczema. Design and setting Qualitative interview study in UK primary care within the Trial of Eczema allergy Screening Tests feasibility trial. Participants Semi-structured interviews with parents of children with eczema taking part in the feasibility study and GPs at practices hosting the study. Results 21 parents and 11 GPs were interviewed. Parents discussed a range of potential causes for eczema, including a role for food allergy. They believed allergy testing to be beneficial as it could potentially identify a cure or help reduce symptoms and they found negative tests reassuring, suggesting to them that no dietary changes were needed. GPs reported limited experience and uncertainty regarding food allergy in children with eczema. While some GPs believed referral for allergy testing could be appropriate, most were unclear about its utility. They thought it should be reserved for children with severe eczema or complex problems but wanted more information to advise parents and help guide decision making. Conclusions Parents' motivations for allergy testing are driven by the desire to improve their child's condition and exclude food allergy as a possible cause of symptoms. GPs are uncertain about the role of allergy testing and want more information about its usefulness to support parents and help inform decision making

A representation scheme for digital product service system definitions.

The growing trend for delivering physical products to customers as parts of product service systems (PSS) is creating a need for a new generation of Computer Aided Design (CAD) system to support the design of PSS: so-called "PSS-CAD". Key research issues in the development of such systems include building understanding of the kinds of applications that designers of PSS might need and the establishment of well-founded representation schemes to underpin and support communication between PSS-CAD systems. Recent literature includes numerous descriptions of integrated PSS development processes, PSS-CAD tools to support these processes and early meta-models to provide information support. This paper complements this work by proposing a representation scheme that is a key prerequisite to achieving the interoperability between PSS-CAD systems which would be necessary to support the deployment of integrated PSS development processes in industry. The representation scheme, a form of meta-model, draws on learning from the product definition community that emerged in the 1970s in response to a need for interoperability between the different shape-based CAD systems that were being developed at the time. The initial focus on shape representation has developed to digital product definitions that define the design of a product coupled with meta-data recording details of processes by which the design was created and, more recently, supported through-life. Similarly, PSS-related information includes both PSS definitions, to support the lifecycles of physical products and associated services, and meta-data needed to support the management of PSS development processes. This paper focuses on information requirements for the definition of service elements of PSS and relationships with product elements and service actors. These requirements are derived from earlier work on the use of service blueprinting for the visualisation and mapping of service activities to deliver different types of service contract. Key information requirements addressed include the need to represent service process flow and breakdown structures, relationships between service and product elements, substitution relationships, and service variants. A representation scheme is proposed and demonstrated through application to a PSS case study. The representation scheme is built on a generic information architecture that has already been applied to problems of product definition; as such there is an underlying compatibility that offers real promise in the future realisation of integrated PSS development processes