Cognitive-behavioural treatment for subacute and chronic neck pain

BACKGROUND: Although research on non-surgical treatments for neck pain (NP) is progressing, there remains uncertainty about the efficacy of cognitive-behavioural therapy (CBT) for this population. Addressing cognitive and behavioural factors might reduce the clinical burden and the costs of NP in society.OBJECTIVES: To assess the effects of CBT among individuals with subacute and chronic NP. Specifically, the following comparisons were investigated: (1) cognitive-behavioural therapy versus placebo, no treatment, or waiting list controls; (2) cognitive-behavioural therapy versus other types of interventions; (3) cognitive-behavioural therapy in addition to another intervention (e.g. physiotherapy) versus the other intervention alone.SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, Web of Science, and PubMed, as well as ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to November 2014. Reference lists and citations of identified trials and relevant systematic reviews were screened.SELECTION CRITERIA: We included randomised controlled trials that assessed the use of CBT in adults with subacute and chronic NP.DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risk of bias in each study and extracted the data. If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was performed. We determined the quality of the evidence for each comparison with the GRADE approach.MAIN RESULTS: We included 10 randomised trials (836 participants) in this review. Four trials (40%) had low risk of bias, the remaining 60% of trials had a high risk of bias.The quality of the evidence for the effects of CBT on patients with chronic NP was from very low to moderate. There was low quality evidence that CBT was better than no treatment for improving pain (standard mean difference (SMD) -0.58, 95% confidence interval (CI) -1.01 to -0.16), disability (SMD -0.61, 95% CI -1.21 to -0.01), and quality of life (SMD -0.93, 95% CI -1.54 to -0.31) at short-term follow-up, while there was from very low to low quality evidence of no effect on various psychological indicators at short-term follow-up. Both at short- and intermediate-term follow-up, CBT did not affect pain (SMD -0.06, 95% CI -0.33 to 0.21, low quality, at short-term follow-up; MD -0.89, 95% CI -2.73 to 0.94, low quality, at intermediate-term follow-up) or disability (SMD -0.10, 95% CI -0.40 to 0.20, moderate quality, at short-term follow-up; SMD -0.24, 95% CI-0.54 to 0.07, moderate quality, at intermediate-term follow-up) compared to other types of interventions. There was moderate quality evidence that CBT was better than other interventions for improving kinesiophobia at intermediate-term follow-up (SMD -0.39, 95% CI -0.69 to -0.08, I(2) = 0%). Finally, there was very low quality evidence that CBT in addition to another intervention did not differ from the other intervention alone in terms of effect on pain (SMD -0.36, 95% CI -0.73 to 0.02) and disability (SMD -0.10, 95% CI -0.56 to 0.36) at short-term follow-up.For patients with subacute NP, there was low quality evidence that CBT was better than other interventions at reducing pain at short-term follow-up (SMD -0.24, 95% CI -0.48 to 0.00), while no difference was found in terms of effect on disability (SMD -0.12, 95% CI -0.36 to 0.12) and kinesiophobia.None of the included studies reported on adverse effects.AUTHORS' CONCLUSIONS: With regard to chronic neck pain, CBT was found to be statistically significantly more effective for short-term pain reduction only when compared to no treatment, but these effects could not be considered clinically meaningful. When comparing both CBT to other types of interventions and CBT in addition to another intervention to the other intervention alone, no differences were found. For patients with subacute NP, CBT was significantly better than other types of interventions at reducing pain at short-term follow-up, while no difference was found for disability and kinesiophobia. Further research is recommended to investigate the long-term benefits and risks of CBT including for the different subgroups of subjects with N

Does cemented or cementless single-stage exchange arthroplasty of chronic periprosthetic hip infections provide similar infection rates to a two-stage? A systematic review

BACKGROUND: The best surgical modality for treating chronic periprosthetic hip infections remains controversial, with a lack of randomised controlled studies. The aim of this systematic review is to compare the infection recurrence rate after a single-stage versus a two-stage exchange arthroplasty, and the rate of cemented versus cementless single-stage exchange arthroplasty for chronic periprosthetic hip infections. METHODS: We searched for eligible studies published up to December 2015. Full text or abstract in English were reviewed. We included studies reporting the infection recurrence rate as the outcome of interest following single- or two-stage exchange arthroplasty, or both, with a minimum follow-up of 12 months. Two reviewers independently abstracted data and appraised quality assessment. RESULTS: After study selection, 90 observational studies were included. The majority of studies were focused on a two-stage hip exchange arthroplasty (65 %), 18 % on a single-stage exchange, and only a 17 % were comparative studies. There was no statistically significant difference between a single-stage versus a two-stage exchange in terms of recurrence of infection in controlled studies (pooled odds ratio of 1.37 [95 % CI = 0.68-2.74, I(2) = 45.5 %]). Similarly, the recurrence infection rate in cementless versus cemented single-stage hip exchanges failed to demonstrate a significant difference, due to the substantial heterogeneity among the studies. CONCLUSION: Despite the methodological limitations and the heterogeneity between single cohorts studies, if we considered only the available controlled studies no superiority was demonstrated between a single- and two-stage exchange at a minimum of 12 months follow-up. The overalapping of confidence intervals related to single-stage cementless and cemented hip exchanges, showed no superiority of either technique

RevManHAL: towards automatic text generation in systematic reviews

Background: Systematic reviews are a key part of healthcare evaluation. They involve important painstaking but repetitive work. A major producer of systematic reviews, the Cochrane Collaboration, employs Review Manager (RevMan) programme—a software which assists reviewers and produces XML-structured files. This paper describes an add-on programme (RevManHAL) which helps auto-generate the abstract, results and discussion sections of RevMan-generated reviews in multiple languages. The paper also describes future developments for RevManHAL. Methods: RevManHAL was created in Java using NetBeans by a programmer working full time for 2 months. Results: The resulting open-source programme uses editable phrase banks to envelop text/numbers from within the prepared RevMan file in formatted readable text of a chosen language. In this way, considerable parts of the review’s ‘abstract’, ‘results’ and ‘discussion’ sections are created and a phrase added to ‘acknowledgements’. Conclusion: RevManHAL’s output needs to be checked by reviewers, but already, from our experience within the Cochrane Schizophrenia Group (200 maintained reviews, 900 reviewers), RevManHAL has saved much time which is better employed thinking about the meaning of the data rather than restating them. Many more functions will become possible as review writing becomes increasingly automated

Relationships between neuronal cell adhesion molecule and LHRH neurons in the urodele brain: a developmental immunohistochemical study

Polysialic acid (PSA), a homopolymer attached to neural cell adhesion molecule (NCAM) is considered a major hallmark of vertebrate cell migration. We studied the distribution of PSA-NCAM by immunohistochemistry, during brain development, in two urodele amphibians, Pleurodeles waltl and the neotenic newt Ambystoma mexicanum. In both species a gradual increase of immunolabelling was observed throughout the brain from developmental stage 30 to stage 52. At the onset of metamorphosis, some differences became evident: in Pleurodeles immunostaining was gradually restricted to the olfactory system while in Ambystoma, PSA-NCAM maintained a more extended distribution (for example throughout the telencephalic walls) suggesting, for the brain of this latter species, a rather preserved neuronal plasticity. The aim of the present work was to correlate the above described PSA-NCAMimmunoreactivity (IR) with the distribution of luteinizing hormone-releasing hormone (LH-RH) containing neurons, which represent a well known example of neural elements migrating from the olfactory placode. LHRH-IR, undetectable till stage 30, was later found together with PSA-NCAM-IR in both the olfactory system and septo-hypothalamic areas. Such observations further support a role of PSA in providing a migration route toward the establishment of a part, at least, of the urodele LHRH system. The possible functional meaning of the LHRH-containing neurons localized between dorsal and ventral thalamus of Ambystoma, never reported before in this area, almost devoid of PSANCAM- IR, is discussed

Likelihood inferences in animal breeding under selection: a missing-data theory view point

Data available in animal breeding are often subject to selection. Such data can be viewed as data with missing values. In this paper, inferences based on likelihoods derived from statistical models for missing data are applied to production records subject to selection. Conditions for ignoring the selection process are discussed.Les données disponibles en génétique animale sont souvent issues d’un processus préalable de sélection. On peut donc considérer comme manquants les attributs (non observés) associés aux individus éliminés, et analyser les données recueillies comme provenant d’un échantillon avec données manquantes. Dans cet article,on développe les méthodes d’inférence fondées sur les vraisemblances, en explicitant dans leur calcul le processus, dû à la sélection, qui induit les données manquantes. On discute les conditions dans lesquelles on peut ignorer la sélection, et donc considérer seulement la vraisemblance des données effectivement recueillies

UNIFORM INTERPOLANTS IN EUF: ALGORITHMS USING DAG-REPRESENTATIONS

The concept of uniform interpolant for a quantifier-free formula from a given formula with a list of symbols, while well-known in the logic literature, has been unknown to the formal methods and automated reasoning community for a long time. This concept is precisely defined. Two algorithms for computing quantifier-free uniform interpolants in the theory of equality over uninterpreted symbols (EUF) endowed with a list of symbols to be eliminated are proposed. The first algorithm is non-deterministic and generates a uniform interpolant expressed as a disjunction of conjunctions of literals, whereas the second algorithm gives a compact representation of a uniform interpolant as a conjunction of Horn clauses. Both algorithms exploit efficient dedicated DAG representations of terms. Correctness and completeness proofs are supplied, using arguments combining rewrite techniques with model theory

Empirical Bayes estimation of parameters for n polygenic binary traits

The conditional probability of an observation in a subpopulation i (a combination of levels of explanatory variables) falling into one of 2n mutually exclusive and exhaustive categories is modelled using a normal integral in n-dimensions. The mean of subpopulation i is written as a linear combination of an unknown vector θ which can include « fixed » effects (e.g., nuisance environmental effects, genetic group effects) and « random » effects such as additive genetic value or producing ability. Conditionally on θ, the normal integral depends on an unknown matrix R comprising residual correlations in a multivariate standard normal conceptual scale. The random variables in θ have a dispersion matrix G X A, where usually A is a known matrix of additive genetic relationships, and G is a matrix of unknown genetic variances and covariances. It is assumed a priori that θ follows a multivariate normal distribution f (θ | G), which does not depend on R, and the likelihood function is taken as product multinomial. The point estimator of θ is the mode of the posterior distribution f (θ | Y, G = G*, R = R*) where Y is data, and G* and R* are the components of the mode of the marginal posterior distribution f (G, R | Y) using « flat » priors for G and R. The matrices G* and R* correspond to the marginal maximum likelihood estimators of the corresponding matrices. The point estimator of θ is of the empirical Bayes types. Overall, computations involve solving 3 non-linear systems in θ, G and R. G* can be computed with an expectation-maximization type algorithm ; an estimator of R* is suggested, and this is related to results published elsewhere on maximum likelihood estimation in contingency tables. Problems discussed include non-linearity, size of the system to be solved, rate of convergence, approximations made and the possible use of informative priors for the dispersion parameters.La probabilité conditionnelle qu’une observation d’une sous-population donnée (combinaison de niveaux de facteurs) se trouve dans l’une des 2" catégories possibles de réponse (exclusives et exhaustives) est modélisée par une intégrale normale à n-dimensions. La moyenne de la ﺎe sous population s’écrit comme une combinaison linéaire d’un vecteur θ de paramètres inconnus qui peuvent comprendre des effets « fixes » (effets de milieu parasites, effets de groupe génétique) et des effets aléatoires (valeur génétique additive ou aptitude à la production). Sachant θ, l’intégrale normale dépend d’une matrice inconnue R fonction des corrélations résiduelles entre les n variables normales sous-jacentes standardisées. Les effets aléatoires de θ présentent une matrice de dispersion de la forme G X A où A est généralement une matrice connue de parenté et G une matrice inconnue de variances et covariances génétiques. On suppose qu’a priori θ suit une loi multinormale de densité f (θ | G) qui ne dépend pas de R. La vraisemblance s’exprime alors comme un produit de multinomiales. L’estimateur de position de θ est défini comme le mode de la distribution a posteriori f (θ | Y, G = G*, R = R*) où Y est le vecteur des données, G* et R* sont les composantes du mode de la distribution marginale f (G, R | Y) avec des a priori uniformes pour G et R. G* et R* correspondent alors aux estimateurs du maximum de vraisemblance marginale et θ à un estimateur de type bayésien empirique. Les calculs impliquent la résolution de 3 systèmes non-linéaires en θ, G et R. G* se calcule selon un algorithme de type E.M. Une approximation de R* est suggérée en relation avec des résultats antérieurs publiés à propos d’une estimation du maximum de vraisemblance pour les tables de contingence. Divers problèmes sont abordés en discussion tels que la non-linéarité, la taille du système à résoudre, la vitesse de convergence, le degré d’approximation et l’emploi possible d’a priori informatifs pour les paramètres de dispersion

Decidable Fragments of LTLf Modulo Theories

We study Linear Temporal Logic Modulo Theories over Finite Traces (LTLMTf), a recently introduced extension of LTL over finite traces (LTLf) where propositions are replaced by first-order formulas and where first-order variables referring to different time points can be compared. In general, LTLMTf was shown to be semi-decidable for any decidable first-order theory (e.g., linear arithmetics), with a tableau-based semi-decision procedure. In this paper we present a sound and complete pruning rule for the LTLMTf tableau. We show that for any LTLMTf formula that satisfies an abstract, semantic condition, that we call finite memory, the tableau augmented with the new rule is also guaranteed to terminate. Last but not least, this technique allows us to establish novel decidability results for the satisfiability of several fragments of LTLMTf, as well as to give new decidability proofs for classes that are already known