Outpatient Management of Low Back and Neck Pain with Radicular Symptoms

Background and Purpose. Neck and back pain are very prevalent in the world today. This pain can range mild to debilitating. The purpose of this case study is to examine the use of physical therapy for patients with neck and back pain. Case Description. A 49 year old female with neck and back pain with radiculopathy. The patient presented with decreased cervical range of motion, kyphotic posture with rounded shoulders and forward head and was seen for a total of six weeks. (20 visits). Intervention. The treatment of the patient involved education on posture/body mechanics/exercises, manual therapy techniques, modalities as needed, movement preferential patterns, dry needling myofascial release. Outcomes. Following physical therapy program the patient achieved full cervical range of motion and a feeling of neck pain being reduced by 85-90%. She also had elimination of numbness and tingling into left upper extremity as well as no complaint of back pain. Patient tolerance to activities improved while being able to sleep through the night with increased her overall quality of life noted. Discussion. Rationale for treatment was based largely on the McKenzie method which showed to be beneficial for the treatment of neck and back pain along with strengthening, myofascial release, dry needling, and e-stim as needed for pain relief

A study of democracy in Africa: The Senegalese experience

This thesis examines the development of democracy in Senegal, one of the few democracies in Africa. In order to understand why democracy has been such a challenge to establish and maintain in Africa, it is necessary to account for the broad effects of European colonization. European powers in their attempts to modernize the people of Africa disrupted their natural cultural progress

The Effects of Patellofemoral Taping on Patellofemoral Joint Alignment and Contact Area

Purpose/Hypothesis: It is widely accepted that patellofemoral pain (PFP) is the result of excessive stress between the retro-patellar surface and the femoral trochlea. Elevated patellofemoral joint (PFJ) stress may be associated with a reduction in PFJ contact area resulting from patellar malalignment (e.g., lateral displacement, lateral tilt, or patellar alta and/or quadriceps imbalance). McConnell and Kinesio taping techniques are commonly used to address PFP and improve PFJ alignment. It has been theorized that PFJ taping can alter the PFJ alignment which may increase the patella’s contact area within the femoral trochlea, thereby resulting in a reduction in PFP. To date, the effects of these 2 taping approaches on PFJ contact area and PFJ alignment have not yet been studied thoroughly. The primary purpose of this study was to use magnetic resonance imaging (MRI) to examine the effects of patellofemoral taping techniques on PFJ alignment and contact area in persons with PFP at 3 knee joint angles (0°, 20°, and 40°). Number of Subjects: Fourteen female subjects with retropatellar pain and PFJ malalignment participated (age: 27.86 ± 5.95 years; weight: 72.15 ± 19.27 kg; height: 1.67 ± .08 m). Methods: Each subject underwent a pre-taping magnetic resonance imaging (MRI) scan session and 2 MRI scan sessions after the application of the 2 taping techniques aiming to correct lateral patellar displacement. Subjects were asked to report their pain using an 11- point numeric rating scale (NRS) while stepping down from a 23-cm step, before and after tape was administered. During each scan session, subjects were loaded with 25% of body weight on their involved/more symptomatic leg at 0°, 20°, and 40° of knee flexion. The outcome measures included patellar lateral displacement (bisect-offset (BSO) index), patellar mediolateral tilt (patellar tilt angle (PTA)), patellar position (Insall-Salvati ratio (ISR)), PFJ contact area, and NRS. PFJ alignment/contact area was compared among the 3 conditions (No tape, Kinesio, and McConnell) at 3 knee angles using a two-way ANOVA with repeated measures. Pain NRS was compared among the 3 conditions using Friedman test and post-hoc Wilcoxon signed-rank tests. Results: The results of the two-way ANOVAs revealed that neither McConnell nor Kinesio taping had significant effects on BSO index (p = 0.488), PTA (p = 0.558), ISR (p = 0.778), and contact area (p = 0.358) across the 3 knee flexion angles. Knee flexion angle had a significant effect on BSO index (p = 0.001) and contact area (p \u3c 0.001). The Friedman test revealed a significant difference in pain level among the 3 conditions. The post-hoc Wilcoxon signed-rank tests further demonstrated that there was a reduction in NRS during step-down test after the application of the Kinesio Taping technique (p=.007). Conclusions: In a weight-bearing condition, our results did not support the premise that applications of PFJ taping using a medial correction technique can alter the PFJ contact area or alignment of the patella. The reduction in pain, following the application of the Kinesio Taping technique performed in this study supports the previous literature on the use of Kinesio Taping techniques for pain management, although the underlying mechanism for the reduction of pain is unclear

MEMS 411: Lift Demonstration

A portable lift demonstration was requested to get children interested and thinking about what happens with fluid movement. The demonstration had size and weight requirements, which were both met. Accuracy of lift force representation was not requested, but simple force and flow visualizations were required. The demonstration had variable wind speeds, and showed the change in force with change in angle of attack

Minimal breast milk transfer of rituximab, a monoclonal antibody used in neurological conditions.

ObjectiveTo determine the transfer of rituximab, an anti-CD20 monoclonal antibody widely used for neurologic conditions, into mature breast milk.MethodsBreast milk samples were collected from 9 women with MS who received rituximab 500 or 1,000 mg intravenous once or twice while breastfeeding from November 2017 to April 2019. Serial breast milk samples were collected before infusion and at 8 hours, 24 hours, 7 days, and 18-21 days after rituximab infusion in 4 patients. Five additional patients provided 1-2 samples at various times after rituximab infusion.ResultsThe median average rituximab concentration in mature breast milk was low at 0.063 μg/mL (range 0.046-0.097) in the 4 patients with serial breast milk collection, with an estimated median absolute infant dose of 0.0094 mg/kg/d and a relative infant dose (RID) of 0.08% (range 0.06%-0.10%). Most patients had a maximum concentration at 1-7 days after infusion. The maximum concentration occurred in a woman with a single breast milk sample and was 0.29 μg/mL at 11 days postinfusion, which corresponds with an estimated RID of 0.33%. Rituximab concentration in milk was virtually undetectable by 90 days postinfusion.ConclusionsWe determined minimal transfer of rituximab into mature breast milk. The RID for rituximab was less than 0.4% and well below theoretically acceptable levels of less than 10%. Low oral bioavailability would probably also limit the absorption of rituximab by the newborn. In women with serious autoimmune neurologic conditions, monoclonal antibody therapy may afford an acceptable benefit to risk ratio, supporting both maternal treatment and breastfeeding

Development of an in vitro thrombosis model to assess endothelial regulation of thrombus formation

Arterial thrombosis culminating in myocardial infarction and stroke remains one of the leading causes of death and disability in the western world. Both in vitro and in vivo thrombosis models have been beneficial tools in furthering our understanding of arterial thrombosis. However, these models are not without limitations, as a result there is not currently a gold standard thrombosis model. Endothelial cells play a key role in regulating platelet activation and thrombus formation, through the activity of endothelial derived platelet inhibitors such as nitric oxide, prostacyclin and CD39. Despite the clear role of endothelial cells in thrombus formation many in vitro thrombosis models lack endothelial cells. These models therefore do not consider the role of the endothelium and endothelial dysfunction in thrombus formation which in turn, inhibits their ability to accurately model atherothrombosis. The aim of this project was to develop a model which incorporates endothelial cells and allows for the assessment of endothelial cell regulation of thrombus formation. Utilising a basic microfluidic model set up, it was successfully demonstrated that incubation of endothelial derived platelet mediators in human whole blood had significant effect on thrombus formation on exposed collagen. Next, endothelial cells were incorporated into the model, the endothelialised model consisted of two separate compartments one lined with endothelial cells, upstream of a second compartment coated with collagen. This novel model setup allowed for the assessment of the effects of endothelial derived mediators on thrombus formation. Incorporation of endothelial cells into the model significantly reduced thrombus formation, thus supporting the hypothesis that endothelial cells should be incorporated into thrombosis models. Accurate replication of the proinflammatory atherothrombotic vessel environment observed in cardiovascular disease was also a key component that needed to be incorporated into the model. TNF-alpha stimulation resulted in an increase in cell adhesion molecules, in addition to a decrease in endothelial nitric oxide synthase phosphorylation. Furthermore, TNF-alpha stimulation of endothelial cells incorporated into the model lead to the abolishment of the previous anti-thrombotic effects observed with endothelial cell incorporation. This confirmed the sensitivity of the model to changes in the endothelial cell compartment, in addition to showing TNF-alpha stimulation could achieve a prothrombotic environment. Optimisation of the model was important to enable a higher throughput and to allow multiple experimental conditions to be modelled simultaneously. The utilisation of a six-syringe pump enabled this optimisation step and enabled the assessment of anti-platelet drug efficacy in the presence of healthy and activated endothelial cells. Further optimisation compared differences between endothelial cells from different vessel beds and demonstrated a significant difference in the levels of platelet mediators in venous and arterial endothelial cells. Finally, the model was used to investigate the ACE2/ANG1-7/MAS signalling axis as a potentially novel anti-thrombotic pathway. The unique dual channel setup, with an endothelial cell channel upstream of a collagen channel, enabled the analysis of the effects of ACE2/ANG1-7/MAS stimulation on endothelial cell regulation of thrombus formation. No significant effects on thrombus formation were observed following ACE2/ANG1-7/MAS stimulation; further studies are required to evaluate the anti-thrombotic effects of this pathway. In conclusion, an in vitro thrombosis model was successfully developed during this project, which included the incorporation of endothelial cells and allowed for the assessment of endothelial cell regulation of platelet activity. It was successfully demonstrated that the model was sensitive to changes in the endothelial compartment both in terms of response to cytokine stimulation and the incorporation of endothelial cells from different vessel beds. In addition, the model’s ability to assess anti-platelet drug efficacy, in the presence of a healthy or activated endothelium was also successfully demonstrated

How Strong Is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations