Failure to define low back pain as a disease or an episode renders research on causality unsuitable: results of a systematic review

Background: Causative factors may be different for the very first onset of symptoms of the 'disease' of low back pain (LBP) than for ensuing episodes that occur after a pain-free period. This differentiation hinges on a life-time absence of low back pain at first onset and short-term absence for further episodes. In this systematic review, we explored whether researchers make these distinctions when investigating the causality of LBP. Methods: A literature search of PUBMED, CINAHL, and SCOPUS databases was performed from January 2010 until September 2016 using the search terms 'low back pain' or 'back pain' and 'risk factor' or 'caus*' or 'predict*' or 'onset' or 'first-time' or 'inception' or 'incidence'. Two reviewers extracted information on study design, types of episodes of back pain to distinguish the disease of LBP and recurring episodes, and also to determine the definitions of disease- or pain-free periods. Results: Thirty-three articles purporting to study causes of LBP were included. Upon scrutiny, 31 of the 33 articles were unclear as to what type of causality they were studying, that of the 'disease' or the episode, or a mere association with LBP. Only 9 studies used a prospective study design. Five studies appeared to investigate the onset of the disease of LBP, however, only one study truly captured the first incidence of LBP, which was the result of sports injury. Six appeared to study episodes but only one clearly related to the concept of episodes. Therefore, among those 11 studies, nine included both first-time LBP and episodes of LBP. Consequently, 22 studies related to the prevalence of LBP, as they probably included a mixture of first-time, recurring and ongoing episodes without distinction. Conclusion: Recent literature concerning the causality of LBP does not differentiate between the 'disease' of LBP and its recurring episodes mainly due to a lack of a clear definition of absence of LBP at baseline. Therefore, current research is not capable of providing a valid answer on this topic

The prognostic merit of self-reported triggers of recurrent low back pain: Study protocol

Background Most cases of low back pain (LBP) are regarded as non-specific and current studies indicate that for many this is a chronic recurrent condition, in which people experience episodes of pain with symptom-free periods in between. It is likely that acute exposure to some factors triggers the reappearance of new episodes in recurrent LBP regardless of the causality of the underlying condition (i.e. risk factors). Additionally, it has been shown that LBP patients present with different trajectories and different trajectories possibly have different triggers. Hence, dividing patients into some clinically meaningful subgroups may offer new insights into triggers, effective preventive strategies and, therefore, prognosis. This study aims to identify self-reported triggers and trajectories of episodes of recurrent LBP and to examine the prognostic association between different triggers and LBP trajectories. Methods This is a longitudinal, multicentre, Australia-wide observational study of patients with recurrent non-specific LBP. Two hundred adults with at least a one-year history of LBP will be recruited from primary care clinics or private practices and followed for a year. Each will receive an SMS every fortnight (26 time-points in total) enquiring the occurrence of a new episode of pain in the past 2 weeks and its intensity. Upon report of a new episode, a telephone interview will be performed to appraise exposure to self-nominated triggers in a period of 24 h preceding the pain. Trajectories will be identified by latent class analysis at the end of the follow-up based on the pain intensity, frequency, and length of episodes. Triggers will be categorised into physical and psychosocial groups. Generalised linear mixed models with logit links will be used to explore pain triggers associated with pain trajectories. Discussion The completion of this study will provide insight into the patients’ self-reported triggers of LBP and also their possible prognostic association with different trajectories. Some newly-identified and pre-identified triggers are likely to be found and reported

Slow, fast and in between: habitat distribution and behaviour of larvae in nine species of libellulid dragonfly

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72093/1/j.1365-2427.2007.01889.x.pd

CLRM-14. OPEN-LABEL, MULTINATIONAL, MULTICENTER, PHASE 3B/4 STUDY OF TRASTUZUMAB DERUXTECAN (T-DXD) IN PATIENTS WITH OR WITHOUT BASELINE BRAIN METASTASIS (BM) WITH PREVIOUSLY TREATED ADVANCED/METASTATIC HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2–POSITIVE BREAST CANCER (HER2+ BC): DESTINY-BREAST12

Abstract BACKGROUND Despite treatment advances, up to 50% of patients with advanced HER2+ BC develop BM (Zimmer. Cancer Rep. 2020). Patients with HER2+ BC with BM have a worse prognosis than patients without BM. In DESTINY-Breast01, T-DXd demonstrated efficacy in the overall population and preliminary efficacy in a subgroup with stable BM, with a confirmed objective response rate (ORR) of 61.4% and an extracranial confirmed ORR by independent central review (ICR) of 58.3%, median progression-free survival (PFS) of 19.4 and 18.1 mo, and median duration of response (DOR) of 20.8 and 16.9 mo (Modi. Cancer Res. 2021; Jerusalem. Ann Oncol. 2020). Here we describe a trial evaluating T-DXd in patients with previously treated advanced/metastatic HER2+ BC ±BM. DESIGN DESTINY-Breast12 (NCT04739761) is an open-label, multicenter, international (86 sites in the US, Europe, Australia, and Japan), phase 3b/4 study assessing T-DXd 5.4 mg/kg q3w efficacy and safety in patients with previously treated advanced/metastatic HER2+ BC ±BM that progressed with ≥1 prior anti-HER2–based regimen and received ≤2 lines of therapy in the metastatic setting (excluding patients with prior tucatinib). Patients (n=250/cohort) will be enrolled in cohort 1 (−BM at baseline) or 2 (+BM at baseline). BM must be untreated and not needing immediate local therapy or previously treated and stable or progressing. Primary endpoints are ORR (cohort 1) and PFS (cohort 2) (both by RECIST version 1.1 per ICR). Secondary endpoints are OS, DOR, time to progression, duration of subsequent therapy, PFS2, safety, and changes in symptoms, functioning, and QOL in both cohorts; incidence of new symptomatic CNS metastasis (CNSM) in cohort 1; and ORR and CNS ORR by RECIST 1.1 per ICR, CNS PFS and DOR, and time to new CNSM in cohort 2. This is an encore; the original presentation will be at The European Society for Medical Oncology 2021

Challenging Perceptions of Disability through Performance Poetry Methods: The "Seen but Seldom Heard" Project.

This paper considers performance poetry as a method to explore lived experiences of disability. We discuss how poetic inquiry used within a participatory arts-based research framework can enable young people to collectively question society’s attitudes and actions towards disability. Poetry will be considered as a means to develop a more accessible and effective arena in which young people with direct experience of disability can be empowered to develop new skills that enable them to tell their own stories. Discussion of how this can challenge audiences to critically reflect upon their own perceptions of disability will also be developed

Non-Walker Self-Dual Neutral Einstein Four-Manifolds of Petrov Type III

The local structure of the manifolds named in the title is described. Although curvature homogeneous, they are not, in general, locally homogeneous. Not all of them are Ricci-flat, which answers an existence question about type III Jordan-Osserman metrics, raised by Diaz-Ramos, Garcia-Rio and Vazquez-Lorenzo (2006).Comment: 47 pages; a reference and a grant number were adde

"Author! Author!" : Shakespeare and biography

Original article can be found at: http://www.informaworld.com/smpp/title~content=t714579626~db=all Copyright Informa / Taylor & Francis Group. DOI: 10.1080/17450910902764454Since 1996, not a year has passed without the publication of at least one Shakespeare biography. Yet for many years the place of the author in the practice of understanding literary works has been problematized, and even on occasions eliminated. Criticism reads the “works”, and may or may not refer to an author whose “life” contributed to their meaning. Biography seeks the author in the works, the personality that precedes the works and gives them their characteristic shape and meaning. But the form of literary biography addresses the unusual kind of “life” that puts itself into “works”, and this is particularly challenging where the “works” predominate massively over the salient facts of the “life”. This essay surveys the current terrain of Shakespeare biography, and considers the key questions raised by the medium: can we know anything of Shakespeare's “personality” from the facts of his life and the survival of his works? What is the status of the kind of speculation that inevitably plays a part in biographical reconstruction? Are biographers in the end telling us as much about themselves as they tell us about Shakespeare?Peer reviewe

e-Surveillance in animal health : use and evaluation of mobile tools

In the last decade, mobile technology offered new opportunities and challenges in animal health surveillance. It began with the use of basic mobile phones and short message service (SMS) for disease reporting, and the development of smartphones and other mobile tools has expanded the possibilities for data collection. These tools assist in the collection of data as well as geo-referenced mapping of diseases, and mapping, visualization and identification of vectors such as ticks. In this article we share our findings about new technologies in the domain of animal health surveillance, based on several projects using a wide range of mobile tools, each with their specific applicability and limitations. For each of the tools used, a comprehensive overview is given about its applicability, limitations, technical requirements, cost and also the perception of the users.The evaluation of the tools clearly shows the importance of selecting the appropriate tool depending on the envisaged data to be collected. Accessibility, visualization and cost related to data collection differ significantly among the tools tested. This paper can thus be seen as a practical guide to the currently available tools.The authors would like to thank the Belgian Science Policy Office (BELSPO) for their financial support of the Stereo II project entitled TickRisk (SR/00/144). Also the Belgian Development Cooperation (DGD) is thanked for their financial support of the FA3 programme. The syndromic livestock disease surveillance in Kenya was supported by the Wellcome Trust, UK (grant number 081828/B/06/Z) and the Compton Foundation, USA.http://journals.cambridge.org/action/displayJournal?jid=PARab201

Stakeholder perceptions of key aspects of high-quality cancer care to assess with patient reported outcome measures: A systematic review

Performance measurement is the process of collecting, analyzing, and reporting standard-ized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and con-flicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers