Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia?

BackgroundCurrent clinical guidelines do not support the use of manual therapy (MT) interventions for Fibromyalgia (FM) patients, despite evidence of positive biochemical, mechanical and psychological effects, and the popularity of hands-on treatments amongst patients. An optimal dose for MT has not been established; this may explain the discrepancies found within the published literature. The aim of this systematic review was to determine whether there is a dose response relationship for MT leading to improvements in core domains of FM symptomology; Pain, Mood, Sleep, Global Measure of Impact (Functional Status & Quality of Life).MethodsWe searched six databases from 1990 to January 2018; studies were evaluated using the PEDro scale. Within-group (ES d) and between-group (ES g) Effect Sizes were calculated.ResultsWe identified and screened 4012 articles, 12 articles were critically appraised. Overall, there is moderate evidence that MT has positive effects on the four clinical outcomes investigated. However, there was no consistent dose response relationship observed across all studies.ConclusionsA dose of approximately 45 min MT, three to five times per week, for three to five weeks, totalling 11 h 15 min, should be considered a baseline generic protocol for treatment delivery and research trials. Further research is necessary to confirm domain specific, or patient specific optimal doses. Moderator variables such as treatment time, frequency, duration; and MT type also need to be explored to ensure optimal delivery of MT in future research and clinical care provision

Global trends affecting the mining industry and the implications for Peru: public report

This report identifies the global trends that are most likely to affect the mining industry over the next decade and considers their implications for Peru. The report begins with an analysis of the institutional context in Peru in 2019, the year in which the study was undertaken. This is followed by a discussion of political, social, environmental, technological and economic trends in that period

Topological entropy and secondary folding

A convenient measure of a map or flow's chaotic action is the topological entropy. In many cases, the entropy has a homological origin: it is forced by the topology of the space. For example, in simple toral maps, the topological entropy is exactly equal to the growth induced by the map on the fundamental group of the torus. However, in many situations the numerically-computed topological entropy is greater than the bound implied by this action. We associate this gap between the bound and the true entropy with 'secondary folding': material lines undergo folding which is not homologically forced. We examine this phenomenon both for physical rod-stirring devices and toral linked twist maps, and show rigorously that for the latter secondary folds occur.Comment: 13 pages, 8 figures. pdfLaTeX with RevTeX4 macro

"From the moment i wake up i will use it?every day, very hour": A qualitative study on the patterns of adolescents' mobile touch screen device use from adolescent and parent perspectives

Background: The use of mobile touch screen devices, e.g. smartphones and tablet computers, has become increasingly prevalent among adolescents. However, little is known about how adolescents use these devices and potential influences on their use. Hence, this qualitative study explored adolescents' perceptions on their patterns of use and factors influencing use, and perceptions and concerns from parents. Methods: Semi-structured interviews were conducted with adolescents (n = 36; 11 to 18 years) and their parents/caregivers (n = 28) in Singapore recruited to represent males and females across a range of ages from different socioeconomic groups. Prompts covered weekday and weekend use patterns, types of activities, perspectives on amount of use, parental control measures and concerns. Interviews were recorded and transcribed. Transcripts were coded and thematic analysis was carried out. Results: Smartphone was the most common mobile device owned and used by many of the adolescents, while only some used a tablet. Many adolescents and their parents felt that adolescents' MTSD use was high, frequent and ubiquitous, with frequent checking of device and multitasking during use. Reported influences of use included functional, personal and external influences. Some of the influences were irresistibility of mobile devices, lack of self-control, entertainment or relaxation value, and high use by peers, family and for schoolwork that contributed to high use, or school/parental control measures and lack of internet availability that limited use. Most adolescents were generally unconcerned about their use and perceived their usage as appropriate, while most parents expressed several concerns about their adolescents' use and perceived their usage as excessive. Conclusions: This study has provided rich insights into the patterns and influences of contemporary mobile device use by adolescents. Mobile device use has become an integral part of adolescents' daily routines, and was affected by several functional, personal and external influences which either facilitated or limited their use. There also seemed to be a strong inclination for adolescents to frequently check and use their mobile devices. There is an urgent need to understand the implications of these common adolescent behaviours to inform advice for wise mobile device use by adolescents