Challenges With Osteopathic Manipulative Medicine Research

A commentary on the challenges with the design and implementation of randomized control studies in OMM researc

The Role of Osteopathic Manipulative Treatment in Neonatal Abstinence Syndrome

Context: The United States opioid epidemic has been an ongoing public health crisis. Nationally, maternal opioid use resulted in 82% increase in Neonatal Abstinence Syndrome (NAS), from 2010 to 2017. The opioid withdrawal process of NAS can lead to somatic dysfunctions. Osteopathic Manipulative Treatment (OMT) may decrease muscular and fascial strain in the body and provide relaxation to the NAS neonate. Objectives: The objectives of this study were to compare the length of hospital stay (LOS) of NAS neonates who received OMT, and neonates given standard medical care without OMT and to evaluate the change in weight of the two groups. Methods: This was a retrospective cohort study of NAS neonates who received either OMT added to standard medical care or standard medical care alone at Berkshire Medical Center (BMC) in Pittsfield, Massachusetts from January 1, 2013, to December 31, 2018. IRB exemption was obtained. Information was obtained from the electronic medical records. Inclusion criteria were neonates delivered at BMC and diagnosed with NAS. Exclusion criteria were neonates transferred to a tertiary care facility. Data was separated into two groups, OMT and standard medical care only. Records were reviewed for LOS and change in weight. The de-identified data was analyzed and compared via T-tests. Results: A total of 175 neonates coded for NAS during the study period, with 2 neonates excluded for transfer, leaving 173 (98.86%) neonates meeting the inclusion criteria. Of the 173 neonates 40 (23.12%) received OMT and 133 (76.88%) received standard medical care only. The LOS for all subjects ranged from 2 to 62 days (M=17.06, SD=10.48). In the OMT group, the LOS ranged from 3 to 45 days (M=17.40, SD=14.8). In the standard medical care-only group the LOS ranged from 2 to 62 days (M=16.61, SD=13.1). There was no significant difference in LOS between the OMT and standard medical care-only groups, t (173) = 0.73, p= 0.649. The change in weight for all subjects ranged from a loss of 15.7 ounces to a gain of 54.1 ounces (M=+7.00, SD=14.12) with an average daily weight gain of 0.4 ounces. In the OMT group the change in weight ranged from a loss of 13.9 ounces to a gain of 51.4 ounces (M=+7.00, SD=11.4) with an average daily weight gain of 0.4 ounces. In the standard medicalcare-only group the change in weight ranged from a loss of 15.7 ounces to a gain of 54.1 ounces (M=+6.40, SD=9.19) with an average daily weight gain of 0.4 ounces. There was no significant difference in weight change between the OMT and standard medical care-only groups, t(170) = 0.03, p= 0.791. Seven providers provided osteopathic consultation and treatment in the OMT group. We reject our hypotheses that there is an association between LOS or weight change in NAS neonates treated with OMT compared to standard medical care only. Conclusion: OMT has previously been shown to have similar or beneficial outcomes to standard medical care. In this study, a direct relationship between LOS or change in weight between NAS neonates treated with OMT compared to standard medical care alone was not found. The findings showed similar low and high ranges in the OMT group compared to the standard medical care only group, suggesting that OMT is a safe option for NAS neonates

Laetoli's lost tracks: 3D generated mean shape and missing footprints.

The Laetoli site (Tanzania) contains the oldest known hominin footprints, and their interpretation remains open to debate, despite over 35 years of research. The two hominin trackways present are parallel to one another, one of which is a composite formed by at least two individuals walking in single file. Most researchers have focused on the single, clearly discernible G1 trackway while the G2/3 trackway has been largely dismissed due to its composite nature. Here we report the use of a new technique that allows us to decouple the G2 and G3 tracks for the first time. In so doing we are able to quantify the mean footprint topology of the G3 trackway and render it useable for subsequent data analyses. By restoring the effectively 'lost' G3 track, we have doubled the available data on some of the rarest traces directly associated with our Pliocene ancestors

Early Origin for Human-Like Precision Grasping: A Comparative Study of Pollical Distal Phalanges in Fossil Hominins

Altres ajuts: Generalitat de Catalunya 2006 FI 00065 i beca de viatge 2008 BE1 00370Background: The morphology of human pollical distal phalanges (PDP) closely reflects the adaptation of human hands for refined precision grip with pad-to-pad contact. The presence of these precision grip-related traits in the PDP of fossil hominins has been related to human-like hand proportions (i.e. short hands with a long thumb) enabling the thumb and finger pads to contact. Although this has been traditionally linked to the appearance of stone tool-making, the alternative hypothesis of an earlier origin-related to the freeing of the hands thanks to the advent of terrestrial bipedalism-is also possible given the human-like intrinsic hand proportion found in australopiths. - Methodology/Principal Findings: We perform morphofunctional and morphometric (bivariate and multivariate) analyses of most available hominin pollical distal phalanges, including Orrorin, Australopithecus, Paranthropous and fossil Homo, in order to investigate their morphological affinities. Our results indicate that the thumb morphology of the early biped Orrorin is more human-like than that of australopiths, in spite of its ancient chronology (ca. 6 Ma). Moreover, Orrorin already displays typical human-like features related to precision grasping. - Conclusions: These results reinforce previous hypotheses relating the origin of refined manipulation of natural objects-not stone tool-making-with the relaxation of locomotor selection pressures on the forelimbs. This suggests that human hand length proportions are largely plesiomorphic, in the sense that they more closely resemble the relatively short-handed Miocene apes than the elongated hand pattern of extant hominoids. With the advent of terrestrial bipedalism, these hand proportions may have been co-opted by early hominins for enhanced manipulative capabilities that, in turn, would have been later co-opted for stone tool-making in the genus Homo, more encephalized than the previous australopiths. This hypothesis remains may be further tested by the finding of more complete hands of unequivocally biped early hominins

Negative phenotypic and genetic associations between copulation duration and longevity in male seed beetles

Reproduction can be costly and is predicted to trade-off against other characters. However, while these trade-offs are well documented for females, there has been less focus on aspects of male reproduction. Furthermore, those studies that have looked at males typically only investigate phenotypic associations, with the underlying genetics often ignored. Here, we report on phenotypic and genetic trade-offs in male reproductive effort in the seed beetle, Callosobruchus maculatus. We find that the duration of a male's first copulation is negatively associated with subsequent male survival, phenotypically and genetically. Our results are consistent with life-history theory and suggest that like females, males trade-off reproductive effort against longevity

The Signaller's Dilemma: A Cost–Benefit Analysis of Public and Private Communication

Understanding the diversity of animal signals requires knowledge of factors which may influence the different stages of communication, from the production of a signal by the sender up to the detection, identification and final decision-making in the receiver. Yet, many studies on signalling systems focus exclusively on the sender, and often ignore the receiver side and the ecological conditions under which signals evolve.We study a neotropical katydid which uses airborne sound for long distance communication, but also an alternative form of private signalling through substrate vibration. We quantified the strength of predation by bats which eavesdrop on the airborne sound signal, by analysing insect remains at roosts of a bat family. Males do not arbitrarily use one or the other channel for communication, but spend more time with private signalling under full moon conditions, when the nocturnal rainforest favours predation by visually hunting predators. Measurements of metabolic CO(2)-production rate indicate that the energy necessary for signalling increases 3-fold in full moon nights when private signalling is favoured. The background noise level for the airborne sound channel can amount to 70 dB SPL, whereas it is low in the vibration channel in the low frequency range of the vibration signal. The active space of the airborne sound signal varies between 22 and 35 meters, contrasting with about 4 meters with the vibration signal transmitted on the insect's favourite roost plant. Signal perception was studied using neurophysiological methods under outdoor conditions, which is more reliable for the private mode of communication.Our results demonstrate the complex effects of ecological conditions, such as predation, nocturnal ambient light levels, and masking noise levels on the performance of receivers in detecting mating signals, and that the net advantage or disadvantage of a mode of communication strongly depends on these conditions

The electric vehicle in smart homes: a review and future perspectives

The electric mobility dissemination is forcing the adoption of new technologies and operation paradigms, not only focusing on smart grids, but also on smart homes. In fact, the emerging technologies for smart homes are also altering the conventional grids toward smart grids. By combining the key pillars of electric mobility and smart homes, this paper characterizes the paradigms of the electric vehicle (EV) in smart homes, presenting a review about the state of the art and establishing a relation with future perspectives. Since the smart home must be prepared to deal with the necessities of the EV, the analysis of both on board and off board battery charging systems are considered in the paper. Moreover, the in-clusion of renewable energy sources, energy storage systems, and dc electrical appliances in smart homes towards sustainability is also considered in this paper, but framed in the perspective of an EV off board battery charging system. As a pertinent contribution, this paper offers future perspectives for the EV in smart homes, including the possibility of ac, dc, and hybrid smart homes. Covering all of these aspects, exemplificative and key results are presented based on numerical simulations and experimental results obtained with a proof of concept prototype.FCT – Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/2019. This work has been supported by the FCT Project newERA4GRIDs PTDC/EEI-EEE/30283/2017, and by the FCT Project DAIPESEV PTDC/EEI-EEE/30382/2017. Tiago Sousa is supported by the doctoral scholarship SFRH/BD/134353/2017 granted by FC

Multifocality and multicentricity are not contraindications for sentinel lymph node biopsy in breast cancer surgery

BACKGROUND: After the availability of the results of validation studies, the sentinel lymph node biopsy (SLNB) has replaced routine axillary dissection (AD) as the new standard of care in early unifocal breast cancers. Multifocal (MF) and multicentric (MC) tumors have been considered a contraindication for this technique due to the possible incidence of a higher false-negative rate. This prospective study evaluates the lymphatic drainage from different tumoral foci of the breast and assesses the accuracy of SLNB in MF-MC breast cancer. PATIENTS AND METHODS: Patients with preoperative diagnosis of MF or MC infiltrating and clinically node-negative (cN0) breast carcinoma were enrolled in this study. Two consecutive groups of patients underwent SLN mapping using a different site of injection of the radioisotope tracer: a) "2ID" Group received two intradermal (ID) injections over the site of the two dominant neoplastic nodules. A lymphoscintigraphic study was performed after each injection to evaluate the route of lymphatic spreading from different sites of the breast. b) "A" Group had periareolar (A) injection followed by a conventional lymphoscintigraphy. At surgery, both radioguided SLNB (with frozen section exam) and subsequent AD were planned, regardless the SLN status. RESULTS: A total 31 patients with MF (n = 12) or MC (n = 19) invasive, cN0 cancer of the breast fulfil the selection criteria. In 2 ID Group (n = 15) the lymphoscintigraphic study showed the lymphatic pathways from two different sites of the breast which converged into one major lymphatic trunk affering to the same SLN(s) in 14 (93.3%) cases. In one (6.7%) MC cancer two different pathways were found, each of them affering to a different SLN. In A Group (n = 16) lymphoscintigraphy showed one (93.7%) or two (6.3%) lymphatic channels, each connecting areola with one or more SLN(s). Identification rate of SLN was 100% in both Groups. Accuracy of frozen section exam on SLN was 96.8% (1 case of micrometastasis was missed). SLN was positive in 13 (41.9%) of 31 patients, including 4 cases (30.7%) of micrometastasis. In 7 of 13 (53.8%) patients the SLN was the only site of axillary metastasis. SLNB accuracy was 96.8% (30 of 31), sensitivity 92.8 (13 of 14), and false-negative rate 7.1% (1 of 14). Since the case of skip metastasis was identified by the surgeon intraoperatively, it would have been no impact in the clinical practice. CONCLUSION: Our lymphoscintigraphic study shows that axillary SLN represents the whole breast regardless of tumor location within the parenchyma. The high accuracy of SLNB in MF and MC breast cancer demonstrates, according with the results of other series published in the literature, that both MF and MC tumors do not represent a contraindication for SLNB anymore

The role of off-board EV battery chargers in smart homes and smart grids: operation with renewables and energy storage systems

Concerns about climate changes and environmental air pollution are leading to the adoption of new technologies for transportation, mainly based on vehicle electrification and the interaction with smart grids, and also with the introduction of renewable energy sources (RES) accompanied by energy storage systems (ESS). For these three fundamental pillars, new power electronics technologies are emerging to transform the electrical power grid, targeting a flexible and collaborative operation. As a distinctive factor, the vehicle electrification has stimulated the presence of new technologies in terms of power management, both for smart homes and smart grids. As the title indicates, this book chapter focuses on the role of off-board EV battery chargers in terms of operation modes and contextualization for smart homes and smart grids in terms of opportunities. Based on a review of on-board and off-board EV battery charging systems (EV-BCS), this chapter focus on the off-board EV-BCS framed with RES and ESS as a dominant system in future smart homes. Contextualizing these aspects, three distinct cases are considered: (1) An ac smart home using separate power converters, according to the considered technologies; (2) A hybrid ac and dc smart home with an off-board EV-BCS interfacing RES and ESS, and with the electrical appliances plugged-in to the ac power grid; (3) A dc smart home using a unified 2 off-board EV-BCS with a single interface for the electrical power grid, and with multiple dc interfaces (RES, ESS, and electrical appliances). The results for each case are obtained in terms of efficiency and power quality, demonstrating that the off-board EV-BCS, as a unified structure for smart homes, presents better results. Besides, the off-board EV-BCS can also be used as an important asset for the smart grid, even when the EV is not plugged-in at the smart home.(undefined

Sexual Display and Mate Choice in an Energetically Costly Environment

Sexual displays and mate choice often take place under the same set of environmental conditions and, as a consequence, may be exposed to the same set of environmental constraints. Surprisingly, however, very few studies consider the effects of environmental costs on sexual displays and mate choice simultaneously. We conducted an experiment, manipulating water flow in large flume tanks, to examine how an energetically costly environment might affect the sexual display and mate choice behavior of male and female guppies, Poecilia reticulata. We found that male guppies performed fewer sexual displays and became less choosy, with respect to female size, in the presence of a water current compared to those tested in still water. In contrast to males, female responsive to male displays did not differ between the water current treatments and females exhibited no mate preferences with respect to male size or coloration in either treatment. The results of our study underscore the importance of considering the simultaneous effects of environmental costs on the sexual behaviors of both sexes