Non-specific mechanisms in orthodox and CAM management of low back pain (MOCAM): theoretical framework and protocol for a prospective cohort study

Introduction

Components other than the active ingredients of treatment can have substantial effects on pain and disability. Such 'non-specific' components include: the therapeutic relationship, the healthcare environment, incidental treatment characteristics, patients' beliefs and practitioners' beliefs. This study aims to: identify the most powerful non-specific treatment components for low back pain (LBP), compare their effects on patient outcomes across orthodox (physiotherapy) and complementary (osteopathy, acupuncture) therapies, test which theoretically derived mechanistic pathways explain the effects of non-specific components and identify similarities and differences between the therapies on patient–practitioner interactions.

Methods and analysis

This research comprises a prospective questionnaire-based cohort study with a nested mixed-methods study. A minimum of 144 practitioners will be recruited from public and private sector settings (48 physiotherapists, 48 osteopaths and 48 acupuncturists). Practitioners are asked to recruit 10–30 patients each, by handing out invitation packs to adult patients presenting with a new episode of LBP. The planned multilevel analysis requires a final sample size of 690 patients to detect correlations between predictors, hypothesised mediators and the primary outcome (self-reported back-related disability on the Roland-Morris Disability Questionnaire). Practitioners and patients complete questionnaires measuring non-specific treatment components, mediators and outcomes at: baseline (time 1: after the first consultation for a new episode of LBP), during treatment (time 2: 2 weeks post-baseline) and short-term outcome (time 3: 3 months post-baseline). A randomly selected subsample of participants in the questionnaire study will be invited to take part in a nested mixed-methods study of patient–practitioner interactions. In the nested study, 63 consultations (21/therapy) will be audio-recorded and analysed quantitatively and qualitatively, to identify communication practices associated with patient outcomes.

Ethics and dissemination

The protocol is approved by the host institution's ethics committee and the NHS Health Research Authority Research Ethics Committee. Results will be disseminated via peer-reviewed journal articles, conferences and a stakeholder workshop.

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The role of financial hardship, mastery and social support in the association between employment status and depression: results from an Australian longitudinal cohort study

Objective

There is robust epidemiological and clinical evidence of the harmful effects of unemployment on psychological well-being, but the mechanisms through which this occurs is still strongly debated. In addition, there is even less evidence on the impact of underemployment on mental health. Using longitudinal data collected from a cohort of 20–24 years old, the present study examines a range of employed states and investigates the role of mastery, financial hardship and social support in the relationship between labour status and depression.

Method

Responses were from the Personality and Total Health (PATH) Through Life Project: A representative, community-based survey conducted in Canberra and Queanbeyan (NSW) in Australia, where respondents (n=2404) in their early twenties were followed for 8 years. Depression was measured using the self-report Goldberg Depression Scale, with the likely presence of depression being indicated by scores 7 or greater.

Results

The analyses identified unemployment and underemployment as significant predictors of depression, compared to their employed counterparts. Both unemployment and underemployment remained significantly correlated with depression even after accounting for sociodemographic, economic and psychological variables. Social support, financial hardship and a sense of personal control (mastery) all emerged as important mediators between unemployment and depression.

Conclusions

Both unemployment and underemployment were associated with increased risk of depression. The strength of this relationship was attenuated but remained significant after accounting for key variables (mastery, financial hardship and social support), and extensive sociodemographic and health covariates, indicating that no or inade­quate employment contributes to poorer mental health over and above these factors.

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Catalysts, Vol. 6, Pages 80: Co-Assembled Supported Catalysts: Synthesis of Nano-Structured Supported Catalysts with Hierarchic Pores through Combined Flow and Radiation Induced Co-Assembled Nano-Reactors

A novel generic method of silica supported catalyst system generation from a fluid state is presented. The technique is based on the combined flow and radiation (such as microwave, thermal or UV) induced co-assembly of the support and catalyst precursors forming nano-reactors, followed by catalyst precursor decomposition. The transformation from the precursor to supported catalyst oxide state can be controlled from a few seconds to several minutes. The resulting nano-structured micro-porous silica supported catalyst system has a surface area approaching 300 m2/g and X-ray Diffraction (XRD)-based catalyst size controlled in the range of 1–10 nm in which the catalyst structure appears as lamellar sheets sandwiched between the catalyst support. These catalyst characteristics are dependent primarily on the processing history as well as the catalyst (Fe, Co and Ni studied) when the catalyst/support molar ratio is typically 0.1–2. In addition, Ca, Mn and Cu were used as co-catalysts with Fe and Co in the evaluation of the mechanism of catalyst generation. Based on extensive XRD, Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM) studies, the micro- and nano-structure of the catalyst system were evaluated. It was found that the catalyst and silica support form extensive 0.6–2 nm thick lamellar sheets of 10–100 nm planar dimensions. In these lamellae, the alternate silica support and catalyst layer appear in the form of a bar-code structure. When these lamellae structures pack, they form the walls of a micro-porous catalyst system which typically has a density of 0.2 g/cm3. A tentative mechanism of catalyst nano-structure formation is provided based on the rheology and fluid mechanics of the catalyst/support precursor fluid as well as co-assembly nano-reactor formation during processing. In order to achieve these structures and characteristics, catalyst support must be in the form of silane coated silica nano-particles dispersed in water which also contains the catalyst precursor nitrate salt. This support-catalyst precursor fluid must have a sufficiently low viscosity but high elastic modulus (high extensional viscosity) to form films and bubbles when exposed to processing energy sources such as microwave, thermal, ultra-sound or UV-radiation or their combination. The micro-to-nano structures of the catalyst system are essentially formed at an early stage of energy input. It is shown that the primary particles of silica are transformed to a proto-silica particle state and form lamellar structures with the catalyst precursor. While the nano-structure is forming, water is evaporated leaving a highly porous solid support-catalyst precursor which then undergoes decomposition to form a silica-catalyst oxide system. The final catalyst system is obtained after catalyst oxide reduction. Although the XRD-based catalyst size changes slightly during the subsequent heat treatments, the nano-structure of the catalyst system remains substantially unaltered as evaluated through TEM images. However, if the catalyst preparation is carried out without film formation, the XRD-based catalyst size increases substantially by a factor of 2–8, with no significant alteration in surface area.

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Symmetry, Vol. 8, Pages 38: On Solutions for Linear and Nonlinear Schrödinger Equations with Variable Coefficients: A Computational Approach

In this work, after reviewing two different ways to solve Riccati systems, we are able to present an extensive list of families of integrable nonlinear Schrödinger (NLS) equations with variable coefficients. Using Riccati equations and similarity transformations, we are able to reduce them to the standard NLS models. Consequently, we can construct bright-, dark- and Peregrine-type soliton solutions for NLS with variable coefficients. As an important application of solutions for the Riccati equation with parameters, by means of computer algebra systems, it is shown that the parameters change the dynamics of the solutions. Finally, we test numerical approximations for the inhomogeneous paraxial wave equation by the Crank-Nicolson scheme with analytical solutions found using Riccati systems. These solutions include oscillating laser beams and Laguerre and Gaussian beams.

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Left ventricular hypertrophy: A rare cardiac involvement of Becker muscular dystrophy

Publication date: Available online 26 May 2016
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Yu Kang, Yu-Cheng Chen, Qing Zhang




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Selective Detection of RGD-Integrin Binding in Cancer Cells Using Tip Enhanced Raman Scattering Microscopy

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b01344

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Enzyme-Immobilized 3D-Printed Reactors for Online Monitoring of Rat Brain Extracellular Glucose and Lactate

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b00272

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