The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis

Background: A 2019 review concluded that spinal manipulative therapy (SMT) results in similar benefit compared to other interventions for chronic low back pain (LBP). Compared to traditional aggregate analyses individual participant data (IPD) meta-analyses allows for a more precise estimate of the treatment effect. Purpose: To assess the effect of SMT on pain and function for chronic LBP in a IPD meta-analysis. Data sources: Electronic databases from 2000 until April 2016, and reference lists of eligible trials and related reviews. Study selection: Randomized controlled trials (RCT) examining the effect of SMT in adults with chronic LBP compared to any comparator. Data extraction and data synthesis: We contacted authors from eligible trials. Two review authors independently conducted the study selection and risk of bias. We used GRADE to assess the quality of the evidence. A one-stage mixed model analysis was conducted. Negative point estimates of the mean difference (MD) or standardized mean difference (SMD) favors SMT. Results: Of the 42 RCTs fulfilling the inclusion criteria, we obtained IPD from 21 (n = 4223). Most trials (s = 12, n = 2249) compared SMT to recommended interventions. There is moderate quality evidence that SMT vs recommended interventions resulted in similar outcomes on pain (MD −3.0, 95%CI: −6.9 to 0.9, 10 trials, 1922 participants) and functional status at one month (SMD: −0.2, 95% CI −0.4 to 0.0, 10 trials, 1939 participants). Effects at other follow-up measurements were similar. Results for other comparisons (SMT vs non-recommended interventions; SMT as adjuvant therapy; mobilization vs manipulation) showed similar findings. SMT vs sham SMT analysis was not performed, because we only had data from one study. Sensitivity analyses confirmed these findings. Limitations: Only 50% of the eligible trials were included. Conclusions: Sufficient evidence suggest that SMT provides similar outcomes to recommended interventions, for pain relief and improvement of functional status. SMT would appear to be a good option for the treatment of chronic LBP. Systematic Review Registration Number PROSPERO CRD4201502571

LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie

LSST Science Book, Version 2.0

A survey that can cover the sky in optical bands over wide fields to faint magnitudes with a fast cadence will enable many of the exciting science opportunities of the next decade. The Large Synoptic Survey Telescope (LSST) will have an effective aperture of 6.7 meters and an imaging camera with field of view of 9.6 deg^2, and will be devoted to a ten-year imaging survey over 20,000 deg^2 south of +15 deg. Each pointing will be imaged 2000 times with fifteen second exposures in six broad bands from 0.35 to 1.1 microns, to a total point-source depth of r~27.5. The LSST Science Book describes the basic parameters of the LSST hardware, software, and observing plans. The book discusses educational and outreach opportunities, then goes on to describe a broad range of science that LSST will revolutionize: mapping the inner and outer Solar System, stellar populations in the Milky Way and nearby galaxies, the structure of the Milky Way disk and halo and other objects in the Local Volume, transient and variable objects both at low and high redshift, and the properties of normal and active galaxies at low and high redshift. It then turns to far-field cosmological topics, exploring properties of supernovae to z~1, strong and weak lensing, the large-scale distribution of galaxies and baryon oscillations, and how these different probes may be combined to constrain cosmological models and the physics of dark energy.Comment: 596 pages. Also available at full resolution at http://www.lsst.org/lsst/sciboo

Caveats of chronic exogenous corticosterone treatments in adolescent rats and effects on anxiety-like and depressive behavior and hypothalamic-pituitary-adrenal (HPA) axis function

<p>Abstract</p> <p>Background</p> <p>Administration of exogenous corticosterone is an effective preclinical model of depression, but its use has involved primarily adult rodents. Using two different procedures of administration drawn from the literature, we explored the possibility of exogenous corticosterone models in adolescence, a time of heightened risk for mood disorders in humans.</p> <p>Methods</p> <p>In experiment 1, rats were injected with 40 mg/kg corticosterone or vehicle from postnatal days 30 to 45 and compared with no injection controls on behavior in the elevated plus maze (EPM) and the forced swim test (FST). Experiment 2 consisted of three treatments administered to rats from postnatal days 30 to 45 or as adults (days 70 to 85): either corticosterone (400 μg/ml) administered in the drinking water along with 2.5% ethanol, 2.5% ethanol or water only. In addition to testing on EPM, blood samples after the FST were obtained to measure plasma corticosterone. Analysis of variance (ANOVA) and alpha level of <it>P </it>< 0.05 were used to determine statistical significance.</p> <p>Results</p> <p>In experiment 1, corticosterone treatment of adolescent rats increased anxiety in the EPM and decreased immobility in the FST compared to no injection control rats. However, vehicle injected rats were similar to corticosterone injected rats, suggesting that adolescent rats may be highly vulnerable to stress of injection. In experiment 2, the intake of treated water, and thus doses delivered, differed for adolescents and adults, but there were no effects of treatment on behavior in the EPM or FST. Rats that had ingested corticosterone had reduced corticosterone release after the FST. Ethanol vehicle also affected corticosterone release compared to those ingesting water only, but differently for adolescents than for adults.</p> <p>Conclusions</p> <p>The results indicate that several challenges must be overcome before the exogenous corticosterone model can be used effectively in adolescents.</p

Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Non-specific low back pain (NSLBP) in subacute and chronic stages can be treated effectively with exercise therapy. Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP. A subgroup of patients with movement control impairment (MCI) improved significantly on patient specific function and disability in a previous case series after movement control exercises.</p> <p>Methods/Design</p> <p>In a randomised controlled trial (RCT) we will compare the effectiveness of movement control and general exercise in patients with MCI. 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practices.</p> <p>Patients randomly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI. The general exercise group will follow an exercise protocol aimed at improving endurance and flexibility. Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home.</p> <p>The primary outcome is the level of disability assessed using the patient specific functional scale (PSFS) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up. Secondary outcomes concern low back pain related disability (Roland Morris questionnaire, RMQ), graded chronic pain scale (GCPS), range of motion and tactile acuity.</p> <p>Discussion</p> <p>To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI. Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our understanding of the mechanisms behind MCI and its relation to NSLBP.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN80064281">ISRCTN80064281</a></p

Avaliação da qualidade de vida com o instrumento SF-36 em lombalgia crônica

OBJETIVO: Avaliar a qualidade de vida através dos domínios do Instrumento SF-36 em portadores de lombalgia crônica inespecífica. MÉTODOS: Trinta portadores de lombalgia crônica inespecífica foram aleatorizados para três grupos (grupo Iso (Isostretching), grupo RPG (Reeducação Postural Global) e Iso+RPG), e avaliados quanto à dor e qualidade de vida antes e após as intervenções fisioterápicas e reavaliados novamente após 2 meses de acompanhamento. Após a aceitação do Termo de Consentimento Livre e Esclarecido os pacientes foram submetidos a procedimentos como: avaliação fisioterápica através do Instrumento de Avaliação da Coluna Vertebral, Escala Visual Analógica de Dor (EVA), Questionário de Qualidade de Vida através do Instrumento SF-36, antes da 1ª sessão e após três meses de tratamento, e reavaliados 2 meses após o tratamento. RESULTADOS: Mostraram que ambas as técnicas fisioterápicas diminuíram a dor (p<0,001), porém quando foram associadas as duas técnicas (Iso + RPG) a melhora da dor foi significativamente maior, e na avaliação após dois meses de acompanhamento o método de RPG foi mais eficaz. Quanto à avaliação da qualidade de vida, as técnicas fisioterápicas foram eficazes após as intervenções (P<0,001), porém o método do Iso foi mais eficaz quando os pacientes foram reavaliados no acompanhamento. CONCLUSÃO: As técnicas fisioterápicas utilizadas neste estudo foram eficazes para tratar a lombalgia crônica inespecífica apresentada pelos pacientes, pois diminuíram a algia que os mesmos apresentavam e melhoraram a qualidade de vida segundo os domínios do Instrumento SF-36. Nível de Evidência II, Ensaio Clínico Controlado e Randomizado. ____________________________________________________________________________________ ABSTRACTThe objective of this study was to evaluate the quality of life (QL) with the use of the SF-36 Questionnaire in patients with chronic nonspecific low back pain (CNLBP). Thirty patients with CNLBP were randomly assigned to one of three groups (Iso group (Isostretching), GPR group (Global Postural Reeducation), and the Iso+GPR group. Patients underwent physical therapy assessment with the use of the Vertebral Spine Assessment, the Visual Analog Scale of Pain (VASP), and the SF-36 life quality questionnaire before the first session (first assessment), after three months of treatment (second assessment) and reassessed two months after the final session in the follow-up (third assessment). The results indicated that both physical therapy techniques reduced pain (p<0.001); when the techniques (Iso+GPR) were combined, the reduction in pain was significantly greater; and, in the follow-up assessment, the GPR method was more efficient. As for the QL, physical therapy techniques were effective after the interventions (p<0.001), and the Iso method was more effective when patients were reassessed in the follow-up. We conclude that the physical therapy techniques used in this study were efficient to treat CNLBP in the patients since they reduced pain and increased QL according to the results of the SF-36 questionnaire. Level of Evidence II, Randomized Controlled Clinical Trial

Model Cortical Association Fields Account for the Time Course and Dependence on Target Complexity of Human Contour Perception

Can lateral connectivity in the primary visual cortex account for the time dependence and intrinsic task difficulty of human contour detection? To answer this question, we created a synthetic image set that prevents sole reliance on either low-level visual features or high-level context for the detection of target objects. Rendered images consist of smoothly varying, globally aligned contour fragments (amoebas) distributed among groups of randomly rotated fragments (clutter). The time course and accuracy of amoeba detection by humans was measured using a two-alternative forced choice protocol with self-reported confidence and variable image presentation time (20-200 ms), followed by an image mask optimized so as to interrupt visual processing. Measured psychometric functions were well fit by sigmoidal functions with exponential time constants of 30-91 ms, depending on amoeba complexity. Key aspects of the psychophysical experiments were accounted for by a computational network model, in which simulated responses across retinotopic arrays of orientation-selective elements were modulated by cortical association fields, represented as multiplicative kernels computed from the differences in pairwise edge statistics between target and distractor images. Comparing the experimental and the computational results suggests that each iteration of the lateral interactions takes at least ms of cortical processing time. Our results provide evidence that cortical association fields between orientation selective elements in early visual areas can account for important temporal and task-dependent aspects of the psychometric curves characterizing human contour perception, with the remaining discrepancies postulated to arise from the influence of higher cortical areas

Tax revenues in the European Union: Recent trends and challenges ahead

The governments of the European Union are facing important challenges that may impact both their need and their capacity to collect taxes. First, ageing will increase some social spending while reducing the potential of some tax bases such as labour. Second, globalisation has the potential to increase the mobility of capital and of high-skilled workers, making it more difficult to rely on them as a source of revenues. Finally, the desire to shift tax away from labour and to make work pay while retaining the social models will force Member States to find alternative robust tax bases. This paper reviews the most recent trends in taxation in the European Union and discusses several tax policy issues in the light of those coming challenges