Treatment Efficacy, Clinical Utility, and Cost-Effectiveness of Multidisciplinary Biopsychosocial Rehabilitation Treatments for Persistent Low Back Pain: A Systematic Review

Study Design: Systematic review. Objectives: To review the current literature on the treatment efficacy, clinical utility, and cost-effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) for patients suffering from persistent (nonspecific) lower back pain (LBP) in relation to pain intensity, disability, health-related quality of life, and work ability/sick leave. Methods: We carried out a systematic search of Web of Science, Cochrane Library, PubMed Central, EMBASE, and PsycINFO for English- and German-language literature published between January 2010 and July 2017. Study selection consisted of exclusion and inclusion phases. After screening for duplication, studies were excluded on the basis of criteria covering study design, number of participants, language of publication, and provision of information about the intervention. All the remaining articles dealing with the efficacy, utility, or cost-effectiveness of intensive (more than 25 hours per week) MBR encompassing at least 3 health domains and cognitive behavioral therapy–based psychological education were included. Results: The search retrieved 1199 publications of which 1116 were duplicates or met the exclusion criteria. Seventy of the remaining 83 articles did not meet the inclusion criteria; thus 13 studies were reviewed. All studies reporting changes in pain intensity or disability over 12 months after MBR reported moderate effect sizes and/or p-values for both outcomes. The effects on health-related quality of life were mixed, but MBR substantially reduced costs. Overall MBR produced an enduring improvement in work ability despite controversy and variable results. Conclusions: MBR is an effective treatment for nonspecific LBP, but there is room for improvement in cost-effectiveness and impact on sick leave, where the evidence was less compelling

Epidemic reconstruction in a Phylogenetics framework:Transmission trees as partitions of the node set

The reconstruction of transmission trees for epidemics from genetic data has been the subject of some recent interest. It has been demonstrated that the transmission tree structure can be investigated by augmenting internal nodes of a phylogenetic tree constructed using pathogen sequences from the epidemic with information about the host that held the corresponding lineage. In this paper, we note that this augmentation is equivalent to a correspondence between transmission trees and partitions of the phylogenetic tree into connected subtrees each containing one tip, and provide a framework for Markov Chain Monte Carlo inference of phylogenies that are partitioned in this way, giving a new method to co-estimate both trees. The procedure is integrated in the existing phylogenetic inference package BEAST.Comment: 40 pages, 3 figure

A preliminary synthesis of modeled climate change impacts on U.S. regional ozone concentrations

A preliminary investigation was carried out by the US Environmental Protection Agency (EPA) on the impact of regional ozone concentrations on climate change in the country. The main objective of the investigation was to enhance the ability of air quality managers to consider global change in their decisions through improved characterization of the potential effects of global change on air quality, including O3, PM, and Hg. An integrated assessment framework was designed that supported the research and development efforts within the EPA and the academic research professionals. This design recognized the challenges of bridging spatial scales, temporal scales, and disciplines that characterize the global change and regional air quality problem. A major component of the assessment approach involved the development and application of global to regional climate and air quality modeling systems