Efficacy of needle-placement technique in radiofrequency ablation for treatment of lumbar facet arthropathy.

BACKGROUND:Many studies have assessed the efficacy of radiofrequency ablation to denervate the facet joint as an interventional means of treating axial low-back pain. In these studies, varying procedural techniques were utilized to ablate the nerves that innervate the facet joints. To date, no comparison studies have been performed to suggest superiority of one technique or even compare the prevalence of side effects and complications. MATERIALS AND METHODS:A retrospective chart review was performed on patients who underwent a lumbar facet denervation procedure. Each patient's chart was analyzed for treatment technique (early versus advanced Australian), preprocedural visual numeric scale (VNS) score, postprocedural VNS score, duration of pain relief, and complications. RESULTS:Pre- and postprocedural VNS scores and change in VNS score between the two groups showed no significant differences. Patient-reported benefit and duration of relief was greater in the advanced Australian technique group (P=0.012 and 0.022, respectively). The advanced Australian technique group demonstrated a significantly greater median duration of relief (4 months versus 1.5 months, P=0.022). Male sex and no pain-medication use at baseline were associated with decreased postablation VNS scores, while increasing age and higher preablation VNS scores were associated with increased postablation VNS scores. Despite increasing age being associated with increased postablation VNS scores, age and the advanced Australian technique were found to confer greater patient self-reported treatment benefit. CONCLUSION:The advanced Australian technique provides a significant benefit over the early Australian technique for the treatment of lumbar facet pain, both in magnitude and duration of pain relief

Protective ankle muscle activation strategies during quick turning movement in humans

Paper examining ankle muscle activation patterns and their role in protecting against sprain during quick turning movements

Mrs. Jason T. Nicol to Mr. Meredith (1 October 1962)

https://egrove.olemiss.edu/mercorr_pro/1426/thumbnail.jp

A three-dimensional finite element model of maximal grip loading in the human wrist

The aim of this work was to create an anatomically accurate three-dimensional finite element model of the wrist, applying subject-specific loading and quantifying the internal load transfer through the joint during maximal grip. For three subjects, representing the anatomical variation at the wrist, loading on each digit was measured during a maximal grip strength test with simultaneous motion capture. The internal metacarpophalangeal joint load was calculated using a biomechanical model. High-resolution magnetic resonance scans were acquired to quantify bone geometry. Finite element analysis was performed, with ligaments and tendons added, to calculate the internal load distribution. It was found that for the maximal grip the thumb carried the highest load, an average of 72.2 ¡ 20.1 N in the neutral position. Results from the finite element model suggested that the highest regions of stress were located at the radial aspect of the carpus. Most of the load was transmitted through the radius, 87.5 per cent, as opposed to 12.5 per cent through the ulna with the wrist in a neutral position. A fully three-dimensional finite element analysis of the wrist using subject-specific anatomy and loading conditions was performed. The study emphasizes the importance of modelling a large ensemble of subjects in order to capture the spectrum of the load transfer through the wrist due to anatomical variation

Quantifying the expected value of uncertain management choices for over-abundant Greylag Geese

In many parts of the world, conservation successes or global anthropogenic changes have led to increasing native species populations that then compete with human resource use. In the Orkney Islands, Scotland, a 60-fold increase in Greylag Goose Anser anser numbers over 24 years has led to agricultural damages and culling attempts that have failed to prevent population increase. To address uncertainty about why populations have increased, we combined empirical modelling of possible drivers of Greylag Goose population change with expert-elicited benefits of alternative management actions to identify whether to learn versus act immediately to reduce damages by geese. We built linear mixed-effects models relating annual goose densities on farms to land-use and environmental covariates and estimated AICc model weights to indicate relative support for six hypotheses of change. We elicited from experts the expected likelihood that one of six actions would achieve an objective of halting goose population growth, given each hypothesis for population change. Model weights and expected effects of actions were combined in Value of Information analysis (VoI) to quantify the utility of resolving uncertainty in each hypothesis through adaptive management and monitoring. The action with the highest expected value under existing uncertainty was to increase the extent of low quality habitats, whereas assuming equal hypothesis weights changed the best action to culling. VoI analysis showed that the value of learning to resolve uncertainty in any individual hypothesis for goose population change was low, due to high support for a single hypothesis of change. Our study demonstrates a two-step framework that learns about the most likely drivers of change for an over-abundant species, and uses this knowledge to weight the utility of alternative management actions. Our approach helps inform which strategies might best be implemented to resolve uncertainty when there are competing hypotheses for change and competing management choices