Effectiveness and cost-effectiveness of rehabilitation after lumbar disc surgery (REALISE): design of a randomised controlled trial

Background: Patients who undergo lumbar disc surgery for herniated discs, are advocated two different postoperative management strategies: a watchful waiting policy, or referral for rehabilitation immediately after discharge from the hospital. A direct comparison of the effectiveness and cost-effectiveness of these two strategies is lacking. Methods/Design. A randomised controlled trial will be conducted with an economic evaluation alongside to assess the (cost-) effectiveness of rehabilitation after lumbar disc surgery. Two hundred patients aged 18-70 years with a clear indication for lumbar disc surgery of a single level herniated disc will be recruited and randomly assigned to either a watchful waiting policy for first six weeks or exercise therapy starting immediately after discharge from the hospital. Exercise therapy will focus on resumption of activities of daily living and return to work. Therapists will tailor the intervention to the individual patient's needs. All patients will be followed up by the neurosurgeon six weeks postoperatively. Main outcome measures are: functional status, pain intensity and global perceived recovery. Questionnaires will be completed preoperatively and at 3, 6, 9, 12 and 26 weeks after surgery. Data will be analysed according to the intention-to-treat principle, using a linear mixed model for continuous outcomes and a generalised mixed model for dichotomous outcomes. The economic evaluation will be performed from a societal perspective. Discussion. The results of this trial may lead to a more consistent postoperative strategy for patients who will undergo lumbar disc surgery. Trial registration. Netherlands Trial Register: NTR3156. © 2013 Oosterhuis et al.; licensee BioMed Central Ltd

Robust process windows for Laser Induced Forward Transfer of thin film metal to create inter connects

Direct-write technologies can form a low-cost, alternative approach to create electrical interconnects by eliminating mask and etch costs. Also, direct-write is more efficient in creating complex structures as well as for producing small series. However, existing, industrially-mature direct-write technologies typically lack the resolution required for advanced IC packaging applications [1-4]. Laser Induced Forward Transfer (LIFT) is a direct write process which has been proven to be capable of patterning resolutions in the 1-5 μm range [5-8]. Thus far, a lack of deposition control resulting in contamination of the substrate has been a problem. The current paper shows an approach to come to a robust, contamination-free process window for LIFT of pure copper. Thus, we tackled a major roadblock towards the industrial feasibility of LIFT as a full metal direct-write technology that meets the current demands for IC packaging and integration

Peribiliary glands are key in regeneration of the human biliary epithelium after severe bile duct injury

Peribiliary glands (PBG) are a source of stem/progenitor cells organized in a cellular network encircling large bile ducts. Severe cholangiopathy with loss of luminal biliary epithelium has been proposed to activate PBG, resulting in cell proliferation and differentiation to restore biliary epithelial integrity. However, formal evidence for this concept in human livers is lacking. We, therefore, developed a novel ex vivo model using precision-cut slices of extrahepatic human bile ducts obtained from discarded donor livers, providing an intact anatomical organization of cell structures, to study spatiotemporal differentiation and migration of PBG cells after severe biliary injury. Post-ischemic bile duct slices were incubated in oxygenated culture medium for up to a week. At baseline, severe tissue injury was evident with loss of luminal epithelial lining and mural stroma necrosis. In contrast, PBG remained relatively well preserved and different reactions of PBG were noted, including PBG dilatation, cell proliferation and maturation. Proliferation of PBG cells increased after 24 h of oxygenated incubation, reaching a peak after 72 h. Proliferation of PBG cells was paralleled by a reduction in PBG apoptosis and differentiation from a primitive and pluripotent (Nanog+/Sox9+) to a mature (CFTR+/secretin receptor+) and activated phenotype (increased expression of HIF-1α, Glut-1, and VEGF-A). Migration of proliferating PBG cells in our ex vivo model was unorganized, but resulted in generation of epithelial monolayers at stromal surfaces. CONCLUSION: Human PBG contain biliary progenitor cells and are able to respond to bile duct epithelial loss with proliferation, differentiation, and maturation to restore epithelial integrity. The ex vivo spatiotemporal behaviour of human PBG cells provides evidence for a pivotal role of PBG in biliary regeneration after severe injury. This article is protected by copyright. All rights reserved

Theory of Change thinking applied in MSPs

On Wednesday 19 September 2012, Centre for Development Innovation, Wageningen UR together with SNV organised a full-day seminar to discuss the application of the now widely used Theory of Change (ToC) thinking in Multi-Stakeholder Processes. This is a report of the seminar

Vulnerability to xylem cavitation and the distribution of sonoran desert vegetation

Journal ArticleWe studied 15 riparian and upland Sonoran desert species to evaluate how the limitation of xylem pressure (Vx) by cavitation corresponded with plant distribution along a moisture gradient. Riparian species were obligate riparian trees (Fraxinus velutina, Populus fremontii, and Salix gooddingii), native shrubs (Baccharis spp.), and an exotic shrub (Tamarix ramosissima). Upland species were evergreen (Juniperus monosperma, Larrea tridentata), drought-deciduous (Ambrosia dumosa, Encelia farinosa, Fouquieria splendens, Cercidium microphyllum), and winter-deciduous (Acacia spp., Prosopis velutina) trees and shrubs

Cultivars to face climate change effects on crops and weeds: a review

International audienceAbstractClimate change is caused by the release of greenhouse gases in the atmosphere. Climate change will impact many activities, but its effects on agricultural production could be acute. Estimates of annual damages in agriculture due to temperature increase or extended periods of drought will be more costly than damages in other activities. Yield losses are caused both by direct effects of climate change on crops and by indirect effects such as increased inputs in crop production for weed control. One possible solution to counteract the effects of climate change is to seek crop cultivars that are adapted to highly variable, extreme climatic conditions and pest changes. Here we review the effects of climate change on crop cultivars and weeds. Biomass increase will augment marketable yield by 8–70 % for C3 cereals, by 20–144 % for cash and vegetable crops, and by 6–35 % for flowers. Such positive effects could however be reduced by decreasing water and nutrient availability. Rising temperature will decrease yields of temperature-sensitive crops such as maize, soybean, wheat, and cotton or specialty crops such as almonds, grapes, berries, citrus, or stone fruits. Rice, which is expected to yield better under increased CO2, will suffer serious yield losses under high temperatures. Drought stress should decrease the production of tomato, soybean, maize, and cotton. Nevertheless, reviews on C4 photosynthesis response to water stress in interaction with CO2 concentration reveal that elevated CO2 concentration lessens the deleterious effect of drought on plant productivity. C3 weeds respond more strongly than C4 types to CO2 increases through biomass and leaf area increases. The positive response of C3 crops to elevated CO2 may make C4 weeds less competitive for C3 crops, whereas C3 weeds in C4 or C3 crops could become a problem, particularly in tropical regions. Temperature increases will mainly affect the distribution of weeds, particularly C4 type, by expanding their geographical range. This will enhance further yield losses and will affect weed management systems negatively. In addition, the expansion of invasive weed species such as itchgrass, cogongrass, and witchweed facilitated by temperature increases will increase the cost for their control. Under water or nutrient shortage scenarios, an r-strategist with characteristics in the order S-C-R, such as Palmer amaranth, large crabgrass, johnsongrass, and spurges, will most probably prevail. Selection of cultivars that secure high yields under climate change but also by competing weeds is of major importance. Traits related with (a) increased root/shoot ratio, (b) vernalization periods, (c) maturity, (d) regulation of node formation and/or internode distance, (e) harvest index variations, and (f) allelopathy merit further investigation. The cumulative effects of selecting a suitable stress tolerator-competitor cultivar will be reflected in reductions of environmental pollution, lower production costs, and sustainable food production