Prevention of relapsing backache

Background: The condition of non-specific back pain is characterized by high prevalence, non satisfactory therapeutic options and severe socioeconomic consequences. Therefore prevention seems an attractive option to downsize the problem. However, the construction of effective preventive measures is complicated by the obscure aetiology of the condition, the multidimensionality of risk and prognostic factors (bio psychosocial model!) and the variability of its natural as well as clinical course. This led to the development of a wide variety of preventive measures: e. g. exercise programs, educational measures (including back school), ergonomic modification of the work environment, mechanical supports (e. g. back belts) as well as multidisciplinary interventions. For two reasons the workplace seems to be a suitable setting for prevention. First, because a number of strong risk factors are associated with working conditions and second, because it allows addressing a large proportion of the adult population. Against this background the assessment at hand sets out to answer the following questions: What is the amount and methodological quality of the available scientific literature on the effectiveness of back pain prevention in the workplace environment? What are effective measures for the prevention of back pain and its consequences in the workplace environment and how effective are they? Is back pain prevention in the workplace environment cost-effective? Is there a need for more research? As primary outcomes for effectiveness the assessment will focus on time lost from work and the frequency and duration of episodes with back pain. The preventive measures assessed belong to the following categories: exercise programs, educational and information measures, multidimensional interventions, back belts, lifting teams and ergonomic interventions. Methods: The assessment is based on a systematic review of the published literature according to the methodological requirements of DAHTA. Proceedings of the electronic literature searches are documented in the appendix. In addition references of review articles were searched. Methodological quality of publications (systematic reviews, HTA reports) was assessed using the checklists developed by the German Scientific Working Group for Technology Assessment in Health Care (GSWGTAHC) or with the Jadad-Score (controlled trials) respectively. Due to the large number of relevant publications the assessment is mainly based on data reported by systematic reviews and supplemented by the results of newer trials. A separate economic assessment was not performed because of the low amount of available data. An assessment of ethical, legal and social impact was omitted due to resource constraints.ResultsFor preventive interventions based on exercise programs most of the analysed trials demonstrate some effectiveness. Due to the heterogeneity of the programs it is not possible to conclude whether positive effects are associated with a special type, duration or intensity of exercise. For purely educational measures or information strategies applied in a workplace setting the available trials were not able to demonstrate effectiveness. Back school programs, which in addition to theoretical instructions offer intensive exercising may in the short term, be successful in reducing the incidence of new episodes of back pain. Some trials in high risk groups demonstrate effectiveness of multidimensional interventions on time lost from work. These programs include education and exercise as well as cognitive behavioural interventions to change pain perception. The assessment of the benefits of back belts for the prevention of back pain is based on results of high quality efficacy as well as effectiveness trials. Their results imply for the otherwise healthy working population no protective effect of back belts on time lost from work due to back pain, on the incidence of painful episodes or on days with impairment by back pain. So far there are no data from controlled trials that demonstrate the effectiveness of "lifting teams" in nursing care to prevent back pain or its consequences. However, results from uncontrolled pilot studies indicate a potential for effectiveness. Among "ergonomic interventions" three different approaches have to be distinguished: interventions addressing changes of the workplace setting, interventions addressing the individual's behaviour and combined interventions. Studies evaluating the effectiveness of setting interventions (modification of the physical workplace environment, changes of production processes, organisational changes) yield no dependable results. This conclusion is not based on indifferent trial results but rather on the lack of methodologically sound studies. Results from studies on ergonomic interventions addressing the individual confirm the conclusions drawn for exercise and educational measures. The most marked results are found in trials that examine the effectiveness of combined interventions in high risk groups and contain a strong participatory component. Hardly any of the trials studying the effects of ergonomic interventions satisfied methodological quality criteria that are accepted standard for clinical or public health intervention studies. There were no data allowing firm conclusions on the cost-effectiveness of interventions from any of the categories. Discussion: The significance of the results of the assessment at hand is strongly limited by the comprehensiveness of the questions addressed. Reviewing the literature on the basis of (even systematic) review articles impairs the differentiated examination of the role of target groups, program contents, application and duration, effect sizes and context factors. While the methodological quality of the review articles is quite high, the quality of individual trials (even those included in the review papers) is highly variable. While most trials examining preventive interventions addressed at individuals satisfy at least some methodological requirements many studies dealing with setting interventions do not. Conclusions: In conclusion, sound scientific evidence for the effectiveness and cost-effectiveness of back pain prevention in the workplace environment is still quite scarce. Further research should include: * The development of interventions guided by the bio psychosocial model of back pain aetiology that combines individual prevention as well as measures addressing the workplace environment. * The integration of results from basic ergonomic research into prevention concepts and the conduct of trials focussing outcomes with relevance to health. * at the workplace setting. * The conduct of qualitative studies to identify factors that impair the effectiveness of prevention programs (e. g. motivation, compliance, people skills). * The integration of cost-effectiveness evaluations into all interventional studies

Nonlinear anisotropic dielectric metasurfaces for ultrafast nanophotonics

We report on the broadband transient optical response from anisotropic nanobrick amorphous silicon particles, exhibiting Mie-type resonances. A quantitative model is developed to identify and disentangle the three physical processes that govern the ultrafast changes of the nanobrick optical properties, namely two-photon absorption, free-carrier relaxation, and lattice heating. We reveal a set of operating windows where ultrafast all-optical modulation of transmission is achieved with full return to zero in 20 ps. This is made possible due to the interplay between the competing nonlinear processes and despite the slow (nanosecond) internal lattice dynamics. The observed ultrafast switching behavior can be independently engineered for both or- thogonal polarizations using the large anisotropy of nanobricks thus allowing ultrafast anisotropy control. Our results categorically ascertain the potential of all-dielectric resonant nanophotonics as a platform for ultrafast optical devices, and reveal the pos- sibility for ultrafast polarization-multiplexed displays and polarization rotators

Serum profile changes in postpartum women with a history of childhood maltreatment: a combined metabolite and lipid fingerprinting study

Koenig AM, Karabatsiakis A, Stoll T, et al. Serum profile changes in postpartum women with a history of childhood maltreatment: a combined metabolite and lipid fingerprinting study. Scientific Reports. 2018;8(1): 3468

Re-evaluation of phytohormone-independent division of tobacco protoplast-derived cells

We have used a [3H] thymidine incorporation assay and microscopic observation in order to reassess recently published data dealing with the response of tobacco protoplasts to phytohormones, lipochitooligosaccharides and peptides (Harling et al., 1997; Hayashi et al., 1992; Miklashevichs et al., 1996; Miklashevichs et al., 1997; Rohrig et al., 1995; Rohrig et al., 1996; van de Sande et al., 1996; Walden et al., 1994). These proliferation assays reveal that, in contrast to published data, isolated cells of the investigated mutant plant lines axi159 (Hayashi et al., 1992; Walden et al., 1994), axi4/1 (Harling et al., 1997) and cyil (Miklashevichs et al., 1997), which were generated by activation T-DNA tagging, were unable to grow in the absence of auxin or cytokinin. Furthermore, lipochitooligosaccharides which play a key role in the induction of nodules on roots of legumes were unable to promote auxin- or cytokinin-independent cell division in tobacco protoplasts as claimed by Rohrig et al. (1995, 1996). The finding of van de Sande et al. (1996) that ENOD40 confers tolerance of high auxin concentration to wild-type tobacco protoplasts was also reinvestigated. The results of our investigations show that we were unable to reproduce the proliferation data presented in this study, which were obtained by counting tobacco protoplast-derived cells undergoing division. In total, none of the published data on phytohormone-independent division of tobacco cells could be reproduced.Peer reviewe

Lévy defects in matrix-immobilized J aggregates : tracing intra-and intersegmental exciton relaxation

L.L. thanks the EC for financial support by the cofunded Amarout program and the Spanish Ministry for economy and competitiveness (plan nacional, Project MultiCrom (CTQ2014-58801)). G.C. acknowledges financial support by the European Research Council (ERC-2011-AdG No. 291198). D.G.L. and D.C. thank the UK EPSRC for funding via research grant EP/M025330/1 “Hybrid Polaritonics”One-dimensional J aggregates present narrow and intense absorption and emission spectra that are interesting for photonics applications. Matrix immobilization of the aggregates, as required for most device architectures, has recently been shown to induce a non-Gaussian (Lévy type) defect distribution with heavy tails, expected to influence exciton relaxation. Here we perform two-dimensional electronic spectroscopy (2DES) in one-dimensional J aggregates of the cyanine dye TDBC, immobilized in a gel matrix, and we quantitatively model 2DES maps by nonlinear optimization coupled to quantum mechanical calculations of the transient excitonic response. We find that immobilization causes strong non-Gaussian off-diagonal disorder, leading to a segmentation of the chains. Intersegmental exciton transfer is found to proceed on the picosecond time scale, causing a long-lasting excitation memory. These findings can be used to inform the design of optoelectronic devices based on J aggregates as they allow for control of exciton properties by disorder management.PostprintPostprintPeer reviewe

A roadmap to improve the quality of atrial fibrillation management:proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference

At least 30 million people worldwide carry a diagnosis of atrial fibrillation (AF), and many more suffer from undiagnosed, subclinical, or 'silent' AF. Atrial fibrillation-related cardiovascular mortality and morbidity, including cardiovascular deaths, heart failure, stroke, and hospitalizations, remain unacceptably high, even when evidence-based therapies such as anticoagulation and rate control are used. Furthermore, it is still necessary to define how best to prevent AF, largely due to a lack of clinical measures that would allow identification of treatable causes of AF in any given patient. Hence, there are important unmet clinical and research needs in the evaluation and management of AF patients. The ensuing needs and opportunities for improving the quality of AF care were discussed during the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference in Nice, France, on 22 and 23 January 2015. Here, we report the outcome of this conference, with a focus on (i) learning from our 'neighbours' to improve AF care, (ii) patient-centred approaches to AF management, (iii) structured care of AF patients, (iv) improving the quality of AF treatment, and (v) personalization of AF management. This report ends with a list of priorities for research in AF patients

Propriétés ultrarapides à la fois électroniques, acoustiques et thermiques de nanoparticules et agrégats métalliques

We used ultrafast time-resolved pump-probe spectroscopy to experimentally investigate the optical response of small metal nano-objects in the few nanometer range (< 2 nm), where a transition from a small solid behaviour to a molecular one is expected. The modification of the intrinsic thermalization processes (electron-electron and electron-phonon interactions) has been studied both on glass-embedded mass-selected silver samples and chemically synthesized ligand-stabilized atomic-defined gold clusters. Electron gas internal thermalization and cooling with the lattice are shown to be affected by size reduction and the concomitant discretization of electronic states. The acoustic response in the same small size range has been investigated. Vibrations of gold clusters were characterized by a quasi-breathing mode scaling with their size, in analogy with larger nanoparticles. The breathing mode of bimetallic core/shell Pt-Au and Ni-Ag nanospheres appeared to be in good quantitative agreement with predictions of continuous elastic models, despite the monoatomic thickness of the layer shell. The same time-resolved approach was used to investigate heat transfer through the nanoparticles interfaces. In this context, heat evacuation of bare or silica-encapsulated goldNous avons étudié par spectroscopie pompe-sonde résolue en temps la réponse optique ultrarapide d'agrégats de très petite taille (< 2 nm), pour lesquelles une transition d'un comportement de type solide à un comportement moléculaire est attendue. Les modifications des processus de thermalisation interne (interactions électrons-électrons et électrons phonons) avec la réduction de taille ont été étudiées dans des nanosphères d'argent triées en masse entourées de silice, et dans des échantillons d'or atomiquement définis stabilisées par des surfactants. Ces expériences ont mis en évidence les effets de confinement quantique des états électroniques sur la cinétique électronique. L'étude des vibrations acoustiques de nanoparticules dans le même régime de taille a été effectuée. Les vibrations observées dans les agrégats d'or sont dominées par leur mode de respiration radial avec une période proportionnelle à leur diamètre, an analogie avec les nanoparticules plus grandes. Le mode de respiration observé sur les nanoobjets bimétalliques de type cœur/couronne Pt-Au et Ni-Ag est en accord quantitatif avec les estimations du modèle élastique macroscopique, malgré une épaisseur de couronne monoatomique. La spectroscopie résolue en temps a également été utilisée pour étudier le transfert de chaleur à travers l'interface d'une nanoparticule sphérique. Dans ce but, l'évacuation de la chaleur dans des nanoparticules d'or, nues ou enrobées de silice, en solution colloïdale a été étudiée expérimentalement et modélisée de manière quantitative grâce à la prise en compte de la contribution de l'environnement (échauffement du solvant) au signal optiqu

Two-Dimensional Electronic Spectroscopy Unravels sub-100 fs Electron and Hole Relaxation Dynamics in Cd-Chalcogenide Nanostructures

We use two-dimensional electronic spectroscopy (2DES) to disentangle the separate electron and hole relaxation pathways and dynamics of CdTe nanorods on a sub-100 fs time scale. By simultaneously exciting and probing the first three excitonic transitions (S1, S2, and S3) and exploiting the unique combination of high temporal and spectral resolution of 2DES, we derive a complete picture for the state-selective carrier relaxation. We find that hot holes relax from the 1Ï3/2to the 1Ï1/2state (S2 â S1) with 30 ± 10 fs time constant, and the hot electrons relax from the Ïâ² to the Ï state (S3 â S1) with 50 ± 10 fs time constant. This observation would not have been possible with conventional transient absorption spectroscopy due to the spectral congestion of the transitions and the very fast relaxation time scales

Two-Dimensional Electronic Spectroscopy Unravels sub-100 fs Electron and Hole Relaxation Dynamics in Cd-Chalcogenide Nanostructures

We use two-dimensional electronic spectroscopy (2DES) to disentangle the separate electron and hole relaxation pathways and dynamics of CdTe nanorods on a sub-100 fs time scale. By simultaneously exciting and probing the first three excitonic transitions (S1, S2, and S3) and exploiting the unique combination of high temporal and spectral resolution of 2DES, we derive a complete picture for the state-selective carrier relaxation. We find that hot holes relax from the 1Ï3/2to the 1Ï1/2state (S2 â S1) with 30 ± 10 fs time constant, and the hot electrons relax from the Ïâ² to the Ï state (S3 â S1) with 50 ± 10 fs time constant. This observation would not have been possible with conventional transient absorption spectroscopy due to the spectral congestion of the transitions and the very fast relaxation time scales

Advances in femto-nano-optics: ultrafast nonlinearity of metal nanoparticles

With the recent advances of experimental techniques, the nonlinear ultrafast optical response of metal nano-objects can now be investigated both on ensembles and on single nanoparticles. Its connection with the metal electronic and lattice kinetics is studied on the basis of a model describing the wavelength and time-dependent modifications of the object material dielectric function. Its application is illustrated in the case of single silver nanospheres and gold nanorods, as well as on ensembles of noble metal nanoparticles and metal-semiconductor nano-hybrids. This quantitative analysis also permits to elucidate the physical mechanisms at the origin of ultrafast nonlinearities in confined metals at different timescales