The back 2 activity trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain.:education and advice versus education and advice plus a structured walking programme for chronic low back pain

BACKGROUND: Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active.

METHODS/DESIGN: The proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a larger randomised controlled trial.

DISCUSSION: This paper describes the rationale and design of a study which will test the feasibility of using a structured, pedometer-driven walking programme in participants with chronic low back pain.

TRIAL REGISTRATION: [ISRCTN67030896].

Bringing values back into evidence-based nursing: the role of patients in resisting empiricism

We examine problems resulting from the narrow empirical focus associated with evidence-based nursing, including the deleterious influence of vested interests, disattention to patients’ experiences, underestimation of the importance of social processes, lack of an individualized research perspective, marginalization of other forms of knowledge, and the undermining of patients’ autonomy. Addressing each problem in turn, we argue that inclusion of patients at all stages of evidence-based practice can counter or ameliorate these problems. While we concede that patient involvement is not a complete solution to the problem of empiricism, it is the most effective means available to defend nursing values.

Interval timing and trajectory in unequal amplitude movements

The Wing-Kristofferson (WK) model of movement timing emphasises the separation of central timer and motor processes. Several studies of repetitive timing have shown that increase in variability at longer intervals is attributable to timer processes; however, relatively little is known about the way motor aspects of timing are affected by task movement constraints. In the present study, we examined timing variability in finger tapping with differences in interval to assess central timer effects, and with differences in movement amplitude to assess motor implementation effects. Then, we investigated whether effects of motor timing observed at the point of response (flexion offset/tap) are also evident in extension, which would suggest that both phases are subject to timing control. Eleven participants performed bimanual simultaneous tapping, at two target intervals (400, 600 ms) with the index finger of each hand performing movements of equal (3 or 6 cm) or unequal amplitude (left hand 3, right hand 6 cm and vice versa). As expected, timer variability increased with the mean interval but showed only small, non-systematic effects with changes in movement amplitude. Motor implementation variability was greater in unequal amplitude conditions. The same pattern of motor variability was observed both at flexion and extension phases of movement. These results suggest that intervals are generated by a central timer, triggering a series of events at the motor output level including flexion and the following extension, which are explicitly represented in the timing system.

Timing and trajectory in rhythm production

The Wing-Kristofferson movement timing model (A. M. Wing & A. B. Kristofferson, 1973a, 1973b) distinguishes central timer and motor implementation processes. Previous studies have shown that increases in interresponse interval (IRI) variability with mean IRI are due to central timer processes, not motor implementation. The authors examine whether this is true with IRI duration changes in binary rhythm production. Ten participants provided IRI and movement data in bimanual synchronous tapping under equal (isochronous) and alternating (rhythm) interval conditions. Movement trajectory changes were observed with IRI duration (300, 500, or 833 ms) and for 500-ms IRIs produced in rhythm contexts (300/500 ms, 500/833 ms). However, application of the Wing-Kristofferson model showed that duration and context effects on IRI variability were attributable largely to timer processes with relatively little effect on motor processes.

Dynamic pricing for used products in remanufacturing with back orders(ABS 3* Journal, Accepted with Revision on 2nd December 2011).

In remanufacturing, the supply of used products and the demand for remanufactured products are usually mismatched because of the great uncertainties on both sides. In this paper, we propose a dynamic pricing policy to balance this uncertain supply and demand. Specifically, we study a remanufacturer’s problem of pricing a single class of cores with random price-dependent returns and random demand for the remanufactured products with backlogs. We model this pricing task as a continuous-time Markov decision process, which addresses both the finite and infinite horizon problems, and provide managerial insights by analyzing the structural properties of the optimal policy. We then use several computational examples to illustrate the impacts of particular system parameters on pricing policy.

From the Land to Sea and Back Again? Using Terrestrial Planning to Understand the Process of Marine Spatial Planning

Over the last 5–10 years, marine spatial planning (MSP) has emerged as a new management regime for national and international waters and has already attracted a substantial body of multi-disciplinary research on its goals and policy processes. This paper argues that this literature has generally lacked deeper reflexive engagement with the emerging system of governance for our seas that has meant that many of MSP’s core concepts, assumptions and institutional arrangements have not been subject rigorous intellectual debate. In an attempt to initiate such an approach, this article explores the relationship between MSP and its land-based cousin, terrestrial spatial planning (TSP). While it is recognized that there are inherent limitations to a comparison of these two systems, it is argued that the tradition of social science debate over the purpose and processes of TSP can be used as a useful stimulus for a more rigorous reflection of such issues as they relate to MSP. The article therefore explores some of the parallels between MSP and TSP and then discusses some of the key intellectual traditions that have shaped TSP and the implications these may have for future marine planning practice. The article concludes with a number of potentially useful new avenues that may form the basis of a critical research agenda for MSP.

Trajectory Control of Electro Hydraulic Excavator using Fuzzy Self Tuning Algorithm with Neural Network

This paper presents the trajectory control of a 2DOF mini electro-hydraulic excavator by using fuzzy self tuning with neural network algorithm. First, the mathematical model is derived for the 2DOF mini electro-hydraulic excavator. The fuzzy PID and fuzzy self tuning with neural network are designed for circle trajectory following. Its two links are driven by an electric motor controlled pump system. The experimental results demonstrated that the proposed controllers have better control performance than the conventional controller.