Preliminary study into the components of the fear-avoidance model of LBP: change after an initial chiropractic visit and influence on outcome

<p>Abstract</p> <p>Background</p> <p>In the last decade the sub grouping of low back pain (LBP) patients according to their likely response to treatment has been identified as a research priority. As with other patient groups, researchers have found few if any factors from the case history or physical examination that are helpful in predicting the outcome of chiropractic care. However, in the wider LBP population psychosocial factors have been identified that are significantly prognostic. This study investigated changes in the components of the LBP fear-avoidance beliefs model in patients pre- and post- their initial visit with a chiropractor to determine if there was a relationship with outcomes at 1 month.</p> <p>Methods</p> <p>Seventy one new patients with lower back pain as their primary complaint presenting for chiropractic care to one of five clinics (nine chiropractors) completed questionnaires before their initial visit (pre-visit) and again just before their second appointment (post-visit). One month after the initial consultation, patient global impression of change (PGIC) scores were collected. Pre visit and post visit psychological domain scores were analysed for any association with outcomes at 1 month.</p> <p>Results</p> <p>Group mean scores for Fear Avoidance Beliefs (FAB), catastrophisation and self-efficacy were all improved significantly within a few days of a patient's initial chiropractic consultation. Pre-visit catastrophisation as well as post-visit scores for catastrophisation, back beliefs (inevitability) and self-efficacy were weakly correlated with patient's global impression of change (PGIC) at 1 month. However when the four assessed psychological variables were dichotomised about pre-visit group medians those individuals with 2 or more high variables post-visit had a substantially increased risk (OR 36.4 (95% CI 6.2-213.0) of poor recovery at 1 month. Seven percent of patients with 1 or fewer adverse psychological variables described poor benefit compared to 73% of those with 2 or more.</p> <p>Conclusions</p> <p>The results presented suggest that catastrophisation, FAB and low self-efficacy could be potential barriers to early improvement during chiropractic care. In most patients presenting with higher psychological scores these were reduced within a few days of an initial chiropractic visit. Those patients who exhibited higher adverse psychology post-initial visit appear to have an increased risk of poor outcome at 1 month.</p

Impact of contextual factors on patient outcomes following conservative low back pain treatment: systematic review

Background and objectiveChronic low back pain is pervasive, societally impactful, and current treatments only provide moderate relief. Exploring whether therapeutic elements, either unrecognised or perceived as implicit within clinical encounters, are acknowledged and deliberately targeted may improve treatment efficacy. Contextual factors (specifically, patient’s and practitioner’s beliefs/characteristics; patient-practitioner relationships; the therapeutic setting/environment; and treatment characteristics) could be important, but there is limited evidence regarding their influence. This research aims to review the impact of interventions modifying contextual factors during conservative care on patient’s pain and physical functioning.Databases and data treatmentFour electronic databases (Medline, CINAHL, PsycINFO and AMED) were searched from 2009 until 15th February 2022, using tailored search strategies, and resulted in 3476 unique citations. After initial screening, 170 full-text records were potentially eligible and assessed against the inclusion–exclusion criteria. Thereafter, studies were assessed for methodological quality using a modified Downs and Black scale, data extracted, and synthesised using a narrative approach.ResultsTwenty-one primary studies (N = 3075 participants), were included in this review. Eight studies reported significant improvements in pain intensity, and seven in physical functioning, in favour of the contextual factor intervention(s). Notable contextual factors included: addressing maladaptive illness beliefs; verbal suggestions to influence symptom change expectations; visual or physical cues to suggest pain-relieving treatment properties; and positive communication such as empathy to enhance the therapeutic alliance.ConclusionThis review identified influential contextual factors which may augment conservative chronic low back pain care. The heterogeneity of interventions suggests modifying more than one contextual factor may be more impactful on patients’ clinical outcomes, although these findings require judicious interpretation

Collaborative knowledge management - A construction case study

Due to the new threats and challenges faced by the construction industry today, construction companies must seek new solutions in order to remain ahead of the competition. Knowledge has been identified to be a significant organisational resource, which if used effectively can provide competitive advantage. A lot of emphasis is being put on how to identify, capture and share knowledge in today's organisations. It has been argued over the years that due to the fragmented nature of the construction industry and ad-hoc nature of the construction projects, capture and reuse of valuable knowledge gathered during a construction project pose a challenge. As a result critical mistakes are repeated on projects and construction professionals have to kee

GMI Instrument Spin Balance Method, Optimization, Calibration, and Test

The Global Microwave Imager (GMI) instrument must spin at a constant rate of 32 rpm continuously for the 3 year mission life. Therefore, GMI must be very precisely balanced about the spin axis and CG to maintain stable scan pointing and to minimize disturbances imparted to the spacecraft and attitude control on-orbit. The GMI instrument is part of the core Global Precipitation Measurement (GPM) spacecraft and is used to make calibrated radiometric measurements at multiple microwave frequencies and polarizations. The GPM mission is an international effort managed by the National Aeronautics and Space Administration (NASA) to improve climate, weather, and hydro-meteorological predictions through more accurate and frequent precipitation measurements. Ball Aerospace and Technologies Corporation (BATC) was selected by NASA Goddard Space Flight Center to design, build, and test the GMI instrument. The GMI design has to meet a challenging set of spin balance requirements and had to be brought into simultaneous static and dynamic spin balance after the entire instrument was already assembled and before environmental tests began. The focus of this contribution is on the analytical and test activities undertaken to meet the challenging spin balance requirements of the GMI instrument. The novel process of measuring the residual static and dynamic imbalances with a very high level of accuracy and precision is presented together with the prediction of the optimal balance masses and their locations

Intra-individual movement variability during skill transitions: A useful marker?

Applied research suggests athletes and coaches need to be challenged in knowing when and how much a movement should be consciously attended to. This is exacerbated when the skill is in transition between two more stable states, such as when an already well learnt skill is being refined. Using existing theory and research, this paper highlights the potential application of movement variability as a tool to inform a coach’s decision-making process when implementing a systematic approach to technical refinement. Of particular interest is the structure of co-variability between mechanical degrees-of-freedom (e.g., joints) within the movement system’s entirety when undergoing a skill transition. Exemplar data from golf are presented, demonstrating the link between movement variability and mental effort as an important feature of automaticity, and thus intervention design throughout the different stages of refinement. Movement variability was shown to reduce when mental effort directed towards an individual aspect of the skill was high (target variable). The opposite pattern was apparent for variables unrelated to the technical refinement. Therefore, two related indicators, movement variability and mental effort, are offered as a basis through which the evaluation of automaticity during technical refinements may be made

Consumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional survey

OBJECTIVES: To investigate (1) self-reported societal comprehension of common and usually non-serious terms found in lumbar spine imaging reports and (2) its relationship to perceived seriousness, likely persistence of low back pain (LBP), fear of movement, back beliefs and history and intensity of LBP. DESIGN: Cross-sectional online survey of the general public. SETTING: Five English-speaking countries: UK, USA, Canada, New Zealand and Australia. PARTICIPANTS: Adults (age >18 years) with or without a history of LBP recruited in April 2019 with quotas for country, age and gender. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported understanding of 14 terms (annular fissure, disc bulge, disc degeneration, disc extrusion, disc height loss, disc protrusion, disc signal loss, facet joint degeneration, high intensity zone, mild canal stenosis, Modic changes, nerve root contact, spondylolisthesis and spondylosis) commonly found in lumbar spine imaging reports. For each term, we also elicited worry about its seriousness, and whether its presence would indicate pain persistence and prompt fear of movement. RESULTS: From 774 responses, we included 677 (87.5%) with complete and valid responses. 577 (85%) participants had a current or past history of LBP of whom 251 (44%) had received lumbar spine imaging. Self-reported understanding of all terms was poor. At best, 235 (35%) reported understanding the term ‘disc degeneration’, while only 71 (10.5%) reported understanding the term ‘Modic changes’. For all terms, a moderate to large proportion of participants (range 59%–71%), considered they indicated a serious back problem, that pain might persist (range 52%–71%) and they would be fearful of movement (range 42%–57%). CONCLUSION: Common and usually non-serious terms in lumbar spine imaging reports are poorly understood by the general population and may contribute to the burden of LBP. TRIAL REGISTRATION NUMBER: ACTRN12619000545167

Pre-transplant antibody screening and anti-CD154 costimulation blockade promote long-term xenograft survival in a pig-to-primate kidney transplant model

Xenotransplantation has the potential to alleviate the organ shortage that prevents many patients with end-stage renal disease from enjoying the benefits of kidney transplantation. Despite significant advances in other models, pig-to-primate kidney xenotransplantation has met limited success. Preformed anti-pig antibodies are an important component of the xenogeneic immune response. To address this, we screened a cohort of 34 rhesus macaques for anti-pig antibody levels. We then selected animals with both low and high titers of anti-pig antibodies to proceed with kidney transplant from galactose-α1,3-galactose knockout/CD55 transgenic pig donors. All animals received T-cell depletion followed by maintenance therapy with costimulation blockade (either anti-CD154 mAb or belatacept), mycophenolate mofetil, and steroid. The animal with the high titer of anti-pig antibody rejected the kidney xenograft within the first week. Low-titer animals treated with anti-CD154 antibody, but not belatacept exhibited prolonged kidney xenograft survival (>133 and >126 vs. 14 and 21 days, respectively). Long-term surviving animals treated with the anti-CD154-based regimen continue to have normal kidney function and preserved renal architecture without evidence of rejection on biopsies sampled at day 100. This description of the longest reported survival of pig-to-non-human primate kidney xenotransplantation, now >125 days, provides promise for further study and potential clinical translation

BAck complaints in the elders - Chiropractic (BACE-C): Protocol of an international cohort study of older adults with low back pain seeking chiropractic care

Background: Low back pain is a common condition among older adults that significantly influences physical function and participation. Compared to their younger counterparts, there is limited information available about the clinical course of low back pain in older people, in particularly those presenting for chiropractic care. Improving our understanding of this patient population and the course of their low back pain may provide input for studies researching safer and more effective care than is currently provided. Objectives: The primary objectives are to examine the clinical course over one year of pain intensity, healthcare costs and pain, functional status and recovery rates of low back pain in people 55 years and older who visit a chiropractor for a new episode of low back pain. Methods: An international prospective, multi-center cohort study with one-year follow-up. Chiropractic practices are to be recruited in the Netherlands, Sweden, United Kingdom and Australia. Treatment will be left to the discretion of the chiropractor. Inclusion/Exclusion criteria: Patients aged 55 and older who consult a chiropractor for a new episode of low back pain, meaning low back pain for the first time or those patients who have not been to a chiropractor in the previous six months. This is independent of whether they have seen another type of health care provider for the current episode. Patients who are unable to complete the web-based questionnaires because of language restrictions or those with computer literacy restrictions will be excluded as well as those with cognitive disorders. In addition, those with a suspected tumor, fracture, infection or any other potential red flag or condition considered to be a contraindication for chiropractic care will be excluded. Data will be collected using online questionnaires at baseline, and at 2 and 6 weeks and at 3, 6, 9 and 12 months. Discussion: This study, to our knowledge, is the first large-scale, prospective, multicenter, international cohort study to be conducted in a chiropractic setting to focus on older adults with low back pain consulting a chiropractor. By understanding the clinical course, satisfaction and safety of chiropractic treatment of this common debilitating condition in the aged population, this study will provide input for informing future clinical trials. Trial registration: Nederlandse Trial Registrar NL7507

Report from the conference, ‘identifying obstacles to applying big data in agriculture’

Data-centric technology has not undergone widespread adoption in production agriculture but could address global needs for food security and farm profitability. Participants in the U.S. Department of Agriculture (USDA) National Institute for Food and Agriculture (NIFA) funded conference, “Identifying Obstacles to Applying Big Data in Agriculture,” held in Houston, TX, in August 2018, defined detailed scenarios in which on-farm decisions could benefit from the application of Big Data. The participants came from multiple academic fields, agricultural industries and government organizations and, in addition to defining the scenarios, they identified obstacles to implementing Big Data in these scenarios as well as potential solutions. This communication is a report on the conference and its outcomes. Two scenarios are included to represent the overall key findings in commonly identified obstacles and solutions: “In-season yield prediction for real-time decision-making”, and “Sow lameness.” Common obstacles identified at the conference included error in the data, inaccessibility of the data, unusability of the data, incompatibility of data generation and processing systems, the inconvenience of handling the data, the lack of a clear return on investment (ROI) and unclear ownership. Less common but valuable solutions to common obstacles are also noted

Comparability: manufacturing, characterization and controls, report of a UK Regenerative Medicine Platform Pluripotent Stem Cell Platform Workshop, Trinity Hall, Cambridge, 14–15 September 2015

This paper summarizes the proceedings of a workshop held at Trinity Hall, Cambridge to discuss comparability and includes additional information and references to related information added subsequently to the workshop. Comparability is the need to demonstrate equivalence of product after a process change; a recent publication states that this ‘may be difficult for cell-based medicinal products’. Therefore a well-managed change process is required which needs access to good science and regulatory advice and developers are encouraged to seek help early. The workshop shared current thinking and best practice and allowed the definition of key research questions. The intent of this report is to summarize the key issues and the consensus reached on each of these by the expert delegates