Pulsed electromagnetic energy treatment offers no clinical benefit in reducing the pain of knee osteoarthritis: a systematic review

Background The rehabilitation of knee osteoarthritis often includes electrotherapeutic modalities as well as advice and exercise. One commonly used modality is pulsed electromagnetic field therapy (PEMF). PEMF uses electro magnetically generated fields to promote tissue repair and healing rates. Its equivocal benefit over placebo treatment has been previously suggested however recently a number of randomised controlled trials have been published that have allowed a systematic review to be conducted. Methods A systematic review of the literature from 1966 to 2005 was undertaken. Relevant computerised bibliographic databases were searched and papers reviewed independently by two reviewers for quality using validated criteria for assessment. The key outcomes of pain and functional disability were analysed with weighted and standardised mean differences being calculated. Results Five randomised controlled trials comparing PEMF with placebo were identified. The weighted mean differences of the five papers for improvement in pain and function, were small and their 95% confidence intervals included the null. Conclusion This systematic review provides further evidence that PEMF has little value in the management of knee osteoarthritis. There appears to be clear evidence for the recommendation that PEMF does not significantly reduce the pain of knee osteoarthritis

Sustainable drainage system site assessment method using urban ecosystem services

The United Kingdom's recently updated approach to sustainable drainage enhanced biodiversity and amenity objectives by incorporating the ecosystem approach and the ecosystem services concept. However, cost-effective and reliable methods to appraise the biodiversity and amenity values of potential sustainable drainage system (SuDS)sites and their surrounding areas are still lacking, as is a method to enable designers to distinguish and link the amenity and biodiversity benefits that SuDS schemes can offer. In this paper, therefore, the authors propose two ecosystem services- and disservices-based methods (i.e. vegetation structure cover-abundance examination and cultural ecosystem services and disservices variables appraisal) to aid SuDS designers to distinguish and link amenity and biodiversity benefits, and allow initial site assessments to be performed in a cost-effective and reliable fashion. Forty-nine representative sites within Greater Manchester were selected to test the two methods. Amenity and biodiversity were successfully assessed and habitat for species, carbon sequestration, recreation and education ecosystem services scores were produced,which will support SuDS retrofit design decision-making. Large vegetated SuDS sites with permanent aquatic features were found to be most capable of enhancing biodiversity- and amenity-related ecosystem services. Habitat for species and recreation ecosystem services were also found to be positively linked to each other. Finally, waste bins on site were found to help reduce dog faeces and litter coverage. Overall, the findings presented here enable future SuDS retrofit designs to be more wildlife friendly and socially inclusive

Are non-slip socks really 'non-slip'? An analysis of slip resistance

Background. Non-slip socks have been suggested as a means of preventing accidental falls due to slips. This study compared the relative slip resistance of commercially available non-slip socks with other foot conditions, namely bare feet, compression stockings and conventional socks, in order to determine any traction benefit. Methods. Phase one involved slip resistance testing of two commercially available non-slip socks and one compression-stocking sample through an independent blinded materials testing laboratory using a Wet Pendulum Test. Phase two of the study involved in-situ testing among healthy adult subjects (n = 3). Subjects stood unsupported on a variable angle, inclined platform topped with hospital grade vinyl, in a range of foot conditions (bare feet, non-slip socks, conventional socks and compression stockings). Inclination was increased incrementally for each condition until slippage of any magnitude was detected. The platform angle was monitored using a spatial orientation tracking sensor and slippage point was recorded on video. Results. Phase one results generated through Wet Pendulum Test suggested that non-slip socks did not offer better traction than compression stockings. However, in phase two, slippage in compression stockings was detected at the lowest angles across all participants. Amongst the foot conditions tested, barefoot conditions produced the highest slip angles for all participants indicating that this foot condition provided the highest slip resistance. Conclusion. It is evident that bare feet provide better slip resistance than non-slip socks and therefore might represent a safer foot condition. This study did not explore whether traction provided by bare feet was comparable to 'optimal' footwear such as shoes. However, previous studies have associated barefoot mobilisation with increased falls. Therefore, it is suggested that all patients continue to be encouraged to mobilise in appropriate, well-fitting shoes whilst in hospital. Limitations of this study in relation to the testing method, participant group and sample size are discussed

Do anti-TNF agents have equal efficacy in patients with rheumatoid arthritis?

Tumor necrosis factor (TNF) antagonists have dramatically improved the outcomes of rheumatoid arthritis (RA). Three agents currently available in the USA – infliximab, etanercept, and adalimumab – have been designed to modify the biologic effects of TNF. Infliximab and adalimumab are monoclonal antibodies, and etanercept is a soluble protein. The pharmacokinetic and pharmacodynamic properties of each differs significantly from those of the others. All three agents are effective and safe, and can improve the quality of life in patients with RA. Although no direct comparisons are available, clinical trials provide evidence that can be used to evaluate the comparative efficacy of these agents. Infliximab, in combination with methotrexate, has been shown to relieve the signs and symptoms of RA, decrease total joint score progression, prevent joint erosions and joint-space narrowing, and improve physical function for up to 2 years. Etanercept has been shown to relieve the signs and symptoms of RA, decrease total joint score progression, and slow the rate of joint destruction, and might improve physical function. Etanercept is approved with and without methotrexate for patients who have demonstrated an incomplete response to therapy with methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs), as well as for first-line therapy in early RA, psoriatic arthritis, and juvenile RA. Adalimumab relieves the signs and symptoms of RA with and without methotrexate and other DMARDs, decreases total joint score progression, prevents joint erosions and joint-space narrowing in combination with methotrexate, and might improve physical function. When selecting a TNF antagonist, rheumatologists should weigh evidence and experience with specific agents before a decision is made for use in therapy

Can\u27t Hold Me Back! Constraint-Induced Movement Therapy for Children with CP: Evidence Based Review

Children with cerebral palsy (CP) have various functional impairments impacting participation in meaningful occupations. While Constraint-Induced Movement Therapy (CIMT) is a widely used intervention for adult populations, a modified version of this technique is a relatively new practice in pediatrics (Charles et al., 2006). Occupational therapy intervention, such as CIMT, can support functional goal attainment to enhance participation and quality of life (Boyd et al., 2010). The purpose of this presentation is to synthesize results of a comprehensive evidence-based review and identify treatment characteristics that impact efficacious use of mCIMT on children with hemiplegic CP. Practitioners will learn about best practice strategies according to current literature. After formulation of a clinical research question, a systematic search of 3 databases was conducted, yielding 15 articles. A rigorous screening process was used with specific inclusion and exclusion criteria. These articles were critiqued to identify the effectiveness of mCIMT. Using Law and MacDermid’s (2008) Appendix M, each article was reviewed by a primary rater with input from a secondary rater. Findings were synthesized and will be discussed in this presentation. The literature review indicated overall positive results for the use of mCIMT with pediatric CP populations. The majority of studies have found statistically significant results, however, there are mixed conclusions regarding clinical effect. A variety of protocol durations and types of constraints have been investigated, and demonstrate that a minimum of 1-2 hours of constraint wear time for 10-14 consecutive days may be effective in a clinic or home environment. Evidence suggests that the most effective mCIMT protocol involves a child-friendly approach using functional and age-appropriate tasks. Both preparatory and occupation-based activities were assessed utilizing a variety of standardized outcome measures. This presentation impacts clinical practice by providing evidence about the most effective intervention characteristics for implementing mCIMT as a useful and feasible treatment approach. Overall, children who received mCIMT by a trained interventionist improved functionally regardless of the protocol. Findings suggest less restrictive methods may be comparable to more intensive mCIMT interventions. Therefore, interventionists can tailor a specific mCIMT approach to meet the unique needs of each child. References: Boyd, R., Sakzewski, L., Ziviani, J., Abbott, D. F., Badawy, R., Gilmore, R., . . . Jackson, G. D. (2010). INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia. BMC Neurology, 10, 1-15. doi:10.1186/1471-2377-10-4 Charles, J. R., Wolf, S. L., Schneider, J. A., & Gordon, A. M. (2006). Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: A randomized control trial. Developmental Medicine and Child Neurology, 48(8), 635-642. doi:10.1017/S0012162206001356 Law, M. & MacDermid, J. (2008). Appendix M: Effectiveness Study Quality Checklist. In Evidence-based rehabilitation: A guide to practice (413-423). Thorofare, NJ: Slack, Inc

Climate change and Australia

Australia has had a variable and mostly arid climate as long as humans have been on the continent. Historically observed trends toward increased warming, with rainfall increases in many tropical areas and rainfall decreases in many temperate areas, are projected to continue. Impacts will be geographically variable but mostly negative for biodiversity, agriculture, and infrastructure. Extreme events such as bushfires and floods will increase in frequency and intensity, concentrated in summer. With an economy heavily dependent on coal for domestic electricity generation and as an export commodity, Australians are high per capita contributors to anthropogenic climate change. A quarter-century of steps to mitigation led in 2012 to a carbon price that has the long-term potential to shift the economy toward more renewable energy sources. However as in other parts of the world this change has come too late, and is proceeding too slowly, to avoid significant climate change. A heritage of indigenous adaptation, strong volunteer cultures, and contemporary cultural diversity provide Australia with considerable adaptive capacity for gradual changes, but the nation is underprepared for sudden or step changes. We identify four pressing research and policy needs focused on such changes: (1) systematic attention to processes and impacts of negative transformative change, or worst-case scenarios, (2) improve forecasts of year-to-year rainfall and climate variability, focusing on processes and climate drivers that may change in response to higher greenhouse gases, (3) identification and engagement of diverse cross-cultural resources, and (4) articulation of alternative governance mechanisms that can interact dynamically with strong government