The use of internet analytics by a Canadian provincial chiropractic regulator to monitor, evaluate and remediate misleading claims regarding specific health conditions, pregnancy, and COVID-19

Background Internet analytics are increasingly being integrated into public health regulation. One specific application is to monitor compliance of website and social media activity with respect to jurisdictional regulations. These data may then identify breaches of compliance and inform disciplinary actions. Our study aimed to evaluate the novel use of internet analytics by a Canadian chiropractic regulator to determine their registrants compliance with three regulations related to specific health conditions, pregnancy conditions and most recently, claims of improved immunity during the COVID-19 crisis. Methods A customized internet search tool (Market Review Tool, MRT) was used by the College of Chiropractors of British Columbia (CCBC), Canada to audit registrants websites and social media activity. The audits extracted words whose use within specific contexts is not permitted under CCBC guidelines. The MRT was first used in October of 2018 to identify words related to specific health conditions. The MRT was again used in December 2019 for words related to pregnancy and most recently in March 2020 for words related to COVID-19. In these three MRT applications, potential cases of word misuse were evaluated by the regulator who then notified the practitioner to comply with existing regulations by a specific date. The MRT was then used on that date to determine compliance. Those found to be non-compliant were referred to the regulator’s inquiry committee. We mapped this process and reported the outcomes with permission of the regulator. Results In September 2018, 250 inappropriate mentions of specific health conditions were detected from approximately 1250 registrants with 2 failing to comply. The second scan for pregnancy related terms of approximately1350 practitioners revealed 83 inappropriate mentions. Following notification, all 83 cases were compliant within the specified timeframe. Regarding COVID-19 related words, 97 inappropriate mentions of the word “immune” were detected from 1350 registrants with 7 cases of non-compliance. Conclusion Internet analytics are an effective way for regulators to monitor internet activity to protect the public from misleading statements. The processes described were effective at bringing about rapid practitioner compliance. Given the increasing volume of internet activity by healthcare professionals, internet analytics are an important addition for health care regulators to protect the public they serve

On the number of kk-cycles in the assignment problem for random matrices

We continue the study of the assignment problem for a random cost matrix. We analyse the number of $k$-cycles for the solution and their dependence on the symmetry of the random matrix. We observe that for a symmetric matrix one and two-cycles are dominant in the optimal solution. In the antisymmetric case the situation is the opposite and the one and two-cycles are suppressed. We solve the model for a pure random matrix (without correlations between its entries) and give analytic arguments to explain the numerical results in the symmetric and antisymmetric case. We show that the results can be explained to great accuracy by a simple ansatz that connects the expected number of $k$-cycles to that of one and two cycles.Comment: To appear in Journal of Statistical Mechanic

Dynamic instabilities induced by asymmetric influence: Prisoners' dilemma game on small-world networks

A two-dimensional small-world type network, subject to spatial prisoners' dilemma dynamics and containing an influential node defined as a special node with a finite density of directed random links to the other nodes in the network, is numerically investigated. It is shown that the degree of cooperation does not remain at a steady state level but displays a punctuated equilibrium type behavior manifested by the existence of sudden breakdowns of cooperation. The breakdown of cooperation is linked to an imitation of a successful selfish strategy of the influential node. It is also found that while the breakdown of cooperation occurs suddenly, the recovery of it requires longer time. This recovery time may, depending on the degree of steady state cooperation, either increase or decrease with an increasing number of long range connections.Comment: 5 pages, 6 figure

Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age

Background. It is unclear to what extent spinal pain varies between genders and in relation to age. It was the purpose of this study to describe the self-reported prevalence of 1) pain ever and pain in the past year in each of the three spinal regions, 2) the duration of such pain over the past year, 3) pain radiating from these areas, and 4) pain in one, two or three areas. In addition, 5) to investigate if spinal pain reporting is affected by gender and 6) to see if it increases gradually with increasing age. Method. A cross-sectional survey was conducted in 2002 on 34,902 twin individuals, aged 20 to 71 years, representative of the general Danish population. Identical questions on pain were asked for the lumbar, thoracic and cervical regions. Results. Low back pain was most common, followed by neck pain with thoracic pain being least common. Pain for at least 30 days in the past year was reported by 12%, 10%, and 4%, respectively. The one-yr prevalence estimates of radiating pain were 22% (leg), 16% (arm), and 5% (chest). Pain in one area only last year was reported by 20%, followed by two (13%) and three areas (8%). Women were always more likely to report pain and they were also more likely to have had pain for longer periods. Lumbar and cervical pain peaked somewhat around the middle years but the curves were flatter for thoracic pain. Similar patterns were noted for radiating pain. Older people did not have pain in a larger number of areas but their pain lasted longer. Conclusion. Pain reported for and from the lumbar and cervical spines was found to be relatively common whereas pain in the thoracic spine and pain radiating into the chest was much less common. Women were, generally, more likely to report pain than men. The prevalence estimates changed surprisingly little over age and were certainly not more common in the oldest groups, although the pain was reported as more long-lasting in the older group

The selfBACK artificial intelligence-based smartphone app can improve low back pain outcome even in patients with high levels of depression or stress

Background: selfBACK provides individually tailored self-management support for low back pain (LBP) via an artificial intelligence-based smartphone app. We explore whether those with depressive/stress symptoms can benefit from this technology. Methods: Secondary analysis of the selfBACK randomized controlled trial (n = 461). Participants with LBP were randomized to usual care (n = 229), or usual care plus selfBACK (n = 232). Primary outcome: LBP-related disability (Roland–Morris Disability Questionnaire, RMDQ) over 9 months. Secondary outcomes: global perceived effect (GPE)/pain self-efficacy (PSEQ)/satisfaction/app engagement. Baseline depressive symptoms were measured using the patient health questionnaire (PHQ-8) and stress with the perceived stress scale (PSS). Outcomes stratified by baseline PHQ-8/PSS scores to assess associations across the whole cohort, and intervention versus control groups. Results: Participants with higher levels of depressive/stress symptoms reported more baseline LBP-related disability (RMDQ 3.1; 1.6 points higher in most vs least depressed/stressed groups respectively); lower self-efficacy (PSEQ 8.1; 4.6 points lower in most vs least depressive/stressed groups respectively). LBP-related disability improved over time; relative risk of improvement in those with greatest depressive/stress symptoms versus nil symptom comparators at 9 months: 0.8 (95% CI: 0.6 to 1.0) and 0.8 (95% CI: 0.7 to 1.0) respectively. No evidence that different baseline levels of depressive/perceived stress symptoms are associated with different RMDQ/GPE/PSEQ outcomes. Whilst participants with higher PHQ-8/PSS were less likely to be satisfied or engage with the app, there was no consistent association among PHQ-8/PSS level, the intervention and outcomes. Conclusions: The selfBACK app can improve outcomes even in those with high levels of depressive/stress symptoms and could be recommended for patients with LBP. Significance: We have demonstrated that an app supporting the self-management of LBP is helpful, even in those with higher levels of baseline depression and stress symptoms. selfBACK offers an opportunity to support people with LBP and provides clinicians with an additional tool for their patients, even those with depression or high levels of stress. This highlights the potential for digital health interventions for chronic pain

Association of Exposures to Seated Postures With Immediate Increases in Back Pain: A Systematic Review of Studies With Objectively Measured Sitting Time

have determined sitting time by self-report and/or LBP by recall following exposure. Given known problems with recall and the validity of estimated sitting time, we conducted a systematic review of studies using objectively measured sitting time to determine if sitting time is associated with immediate LBP in adults. Methods: Four databases (PubMed, EMBASE, SPORTDiscus and CINAHL) were searched from inception to September 1, 2018. Randomized controlled trials, cohort and cross-sectional studies, where objectively measured sitting time was temporally matched with a measure of LBP in adults, were included. Studies without a control session conducted on a separate day were excluded. Screening, full text review, data extraction and risk of bias assessment (QUIPS) of included papers were performed independently by two reviewers, with a third available to resolve disagreements. Results: In total, 609 articles were identified, 361 titles/abstracts were screened,75 full-text articles were assessed for eligibility and 10 met the inclusion criteria. All but one reported sitting time to be associated with immediate increase in LBP. Six of these reported clinically relevant pain levels (n=330). Half of the included studies were rated as having low risk of bias and the remaining as moderate risk of bias. Conclusion: Prolonged sitting increases immediate reporting of LBP in adults; however, no conclusion between sitting and clinical episodes of LBP can be made. Future prospective studies should match objectively measured sitting with temporally related pain measurements to determine whether prolonged sitting can trigger a clinical episode of LBP

Recent Advances in High Temperature Electrolysis at Idaho National Laboratory: Stack Tests

High temperature steam electrolysis is a promising technology for efficient sustainable large-scale hydrogen production. Solid oxide electrolysis cells (SOECs) are able to utilize high temperature heat and electric power from advanced high-temperature nuclear reactors or renewable sources to generate carbon-free hydrogen at large scale. However, long term durability of SOECs needs to be improved significantly before commercialization of this technology. A degradation rate of 1%/khr or lower is proposed as a threshold value for commercialization of this technology. Solid oxide electrolysis stack tests have been conducted at Idaho National Laboratory to demonstrate recent improvements in long-term durability of SOECs. Electrolytesupported and electrode-supported SOEC stacks were provided by Ceramatec Inc., Materials and Systems Research Inc. (MSRI), and Saint Gobain Advanced Materials (St. Gobain), respectively for these tests. Long-term durability tests were generally operated for a duration of 1000 hours or more. Stack tests based on technology developed at Ceramatec and MSRI have shown significant improvement in durability in the electrolysis mode. Long-term degradation rates of 3.2%/khr and 4.6%/khr were observed for MSRI and Ceramatec stacks, respectively. One recent Ceramatec stack even showed negative degradation (performance improvement) over 1900 hours of operation. A three-cell short stack provided by St. Gobain, however, showed rapid degradation in the electrolysis mode. Improvements on electrode materials, interconnect coatings, and electrolyteelectrode interface microstructures contribute to better durability of SOEC stacks

Neck pain and anxiety do not always go together

Chronic pain and psychosocial distress are generally thought to be associated in chronic musculoskeletal disorders such as non-specific neck pain. However, it is unclear whether a raised level of anxiety is necessarily a feature of longstanding, intense pain amongst patient and general population sub-groups. In a cohort of 70 self-selected female, non-specific neck pain sufferers, we observed relatively high levels of self-reported pain of 4.46 (measured on the 11 point numerical pain rating scale (NRS-101)) and a longstanding duration of symptoms (156 days/year). However, the mean anxiety scores observed (5.49), fell well below the clinically relevant threshold of 21 required by the Beck Anxiety Inventory. The cohort was stratified to further distinguish individuals with higher pain intensity (NRS>6) and longer symptom duration (>90 days). Although a highly statistically significant difference (p = 0.000) was subsequently observed with respect to pain intensity, in the resulting sub-groups, none such a difference was noted with respect to anxiety levels. Our results indicate that chronic, intense pain and anxiety do not always appear to be related. Explanations for these findings may include that anxiety is not triggered in socially functional individuals, that individual coping strategies have come into play or in some instances that a psychological disorder like alexithymia could be a confounder. More studies are needed to clarify the specific role of anxiety in chronic non-specific musculoskeletal pain before general evidence-driven clinical extrapolations can be made