Adherence to clinical practice guidelines among three primary contact professions: A best evidence synthesis of the literature for the management of acute and subacute low back pain

Aim: To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature. Methods: A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors. Results: The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%). Conclusions: This review showed that quality papers in this area of research are very limited. Notwithstanding, chiropractors appear to adhere to clinical practice guidelines more so than physiotherapists and medical practitioners, although there is scope for improvement across all three professions

Energy levels of Bk249 populated in the α decay of 99253Es and β- Decay of 96249Cm

The level structure of Bk249 has been investigated by measuring the γ-ray spectra of an extremely pure Es253 sample obtained by milking this nuclide from Cf253 source material produced in the High Flux Isotope Reactor at Oak Ridge National Laboratory. Additional information on the Bk249 levels was obtained from the β - decay study of Cm249, produced by neutron irradiation of Cm248. Using the results of the present study together with the data from previous Cm248(α,t) and Cm248(He3,d) reactions, the following single-particle states have been identified in Bk249: 7/2+[633], 0.0 keV; 3/2-[521], 8.78 keV; 1/2+[400], 377.55 keV; 5/2+[642], 389.17 keV; 1/2-[530], 569.20 keV; 1/2-[521], 643.0 keV; 5/2-[523], 672.9 keV; and 9/2+[624], 1075.1 keV. Four vibrational bands were identified at 767.9, 932.2, 1150.7, and 1223.0 keV with tentative assignments of {7/2+ [633] 1-}9/2-, {7/2+ [633] 0-}7/2-, {7/2+ [633] 1-}5/2-, and {7/2+ [633] 0+}7/2+, respectively. A band at 899.9 keV was observed in γ-γ coincidence measurements and given a tentative spin assignment of 3/2. It is possibly associated with a 2- phonon coupled to the ground state, with configuration {7/2+ [633] 2-}3/2-. Three levels at 624.3, 703.5, and 769.1 keV were assigned spins of 5/2, 7/2, and 9/2, respectively. These could be the members of the 3/2+ [651] band, expected in this energy region

Neutron-capture gamma-ray spectroscopic measurements in the actinide region

From recent neutron capture gamma-ray measurements, experimental data for states involving quasiparticle-vibrational admixtures in /sup 227/Ra, /sup 231/Th, /sup 233/Th, /sup 235/U, /sup 237/U, and /sup 239/U have been compared with theoretical calculations by Soloviev's group. This analysis shows the experimental level structure is more complex than that calculated. In the levels of /sup 250/Bk, four Gallagher-Moszkowski pairs are observed. The moment of inertia for each band with antiparallel alignment of odd-nucleon momenta is systematically larger than for its parallel-aligned mate

Fission of 255,256Es, 255-257Fm, and 258Md at moderate excitation energies

The fission of 255,256Es, 255-257Fm, and 258Md has been studied in the excitation energy range from threshold to 25 MeV. A target of 254Es was used in the direct reaction studies; (d,pf), (t,pf), (3He,df), (3He,pf), and in the compound induced fission reactions formed with p, d, t, and α particle projectiles. Coincident fission fragment energies were recorded along with (in the direct reaction studies) the outgoing light charged particle. The mass and kinetic energy distributions were studied as a function of nuclear excitation energy. The observed bulk properties were consistent with established systematics in that they exhibited an asymmetric mass distribution and a phenomenologically consistent total kinetic energy. However, the systems demonstrated a fission decay mode which we ascribe to high energy symmetric fission decay. This component, though somewhat arbitrary in its definition, showed a general decrease in yield as a function of increasing nuclear excitation energy. This observed rapid change in fission properties between "normal" and high energy symmetric fission probably points to the important observable consequences that can occur from small variations in the potential energy surface.