Pain and motor control of the lumbopelvic region: effect and possible mechanisms

Many authors report changes in the control of the trunk muscles in people with low back pain (LBP). Although there is considerable disagreement regarding the nature of these changes, we have consistently found differential effects on the deep intrinsic and superficial muscles of the lumbopelvic region. Two issues require consideration; first, the potential mechanisms for these changes in control, and secondly, the effect or outcome of changes in control for lumbopelvic function. Recent data indicate that experimentally induced pain may replicate some of the changes identified in people with LBP. While this does not exclude the possibility that changes in control of the trunk muscles may lead to pain, it does argue that, at least in some cases, pain may cause the changes in control. There are many possible mechanisms, including changes in excitability in the motor pathway, changes in the sensory system, and factors associated. with the attention demanding, stressful and fearful aspects of pain. A new hypothesis is presented regarding the outcome from differential effects of pain on the elements of the motor system. Taken together these data argue for strategies of prevention and rehabilitation of LBP (C) 2003 Elsevier Science Ltd. All rights reserved.

Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy

The objectives of this study were to ascertain consumer knowledge and behaviour about hypertension and treatment and to compare these with health care providers' perceptions (of 'most' consumers). The design for the study was a problem detection study (PDS): focus groups and then survey. Focus groups and survey participants were convenience samples of consumers, doctors, nurses and pharmacists. The main outcome measures were agreement on a 5-point Likert scale with statements about consumers' knowledge and behaviour about high blood pressure and medication. The survey identified areas of consensus and disagreement between consumers and health providers. While general knowledge and concordance with antihypertensive therapy among consumers was good, consequences such as eye and kidney disease, interactions with herbal medicines, and how to deal with missing a dose were less well known. Side effects were a problem for over one-quarter of participants, and cost was a problem in continuing therapy. Half the consumers had not received sufficient written information. Providers overall disagreed that most consumers have an adequate understanding of the condition. They agreed that most consumers adhere to therapy and can manage medicines; and about their own profession's role in information provision and condition management. Consumers confirmed positive provider behaviour, suggesting opportunities for greater communication between providers about actions taken with their consumers. In conclusion, the PDS methodology was useful in identifying consumer opinions. Differences between consumer and provider responses were marked, with consumers generally rating their knowledge and behaviour above providers' ratings of 'most' consumers. There are clear gaps to be targeted to improve the outcomes of hypertension therapy.

Medical student radiology training: What are the objectives for contemporary medical practice?

Rationale and Objectives. The authors attempt to provide a set of objectives for medical student training in radiology for contemporary medical practice. Materials and Methods. A questionnaire containing a list of educational objectives was sent to 32 radiologists in charge of medical student training in radiology at accredited residency programs in Australia and New Zealand. The importance of including each preselected objective in the curriculum was measured by respondents' agreement or disagreement on a scale of 1-6. Opportunity also was given to respondents to suggest objectives other than those presented on the questionnaire. Results. Twenty of the 32 questionnaires were returned, and a set of educational objectives was established based on the responses. The objectives were ranked in importance according to the mean score assigned to each objective by the respondents. Conclusion. This new set of educational objectives for medical student radiology training reflects recent changes in radiologic and medical practice and points to potential future developments.

Compiling a caseload index for mental health case management

Objective: The purpose of this study was to explore methods of determining an appropriate caseload for mental health case managers. Method: Seven factors that may impinge on case manager performance and impact on caseload were identified, having reference to published literature and service practice in Victoria and Queensland. The advantages and disadvantages of including these factors in a caseload index were evaluated. Results: Three caseload index methodologies are presented. Each method makes use of different data and has advantages and disadvantages. There is a trade-off between simplicity and ease of application and the comprehensive use of relevant information. Methods vary in their implications for service efficiency and equity in workload distribution. Conclusions: Caseload is a key issue in service planning and staff management. Factors that have the potential to contribute to caseload can be readily identified. However, there is likely to be disagreement as to the weight assigned to any factor and the approach taken may depend on the purpose and context of the caseload calculation. A great deal more research is required to provide an empirical basis for algorithms used in caseload calculation.

Critical fluctuations and entanglement in the nondegenerate parametric oscillator

We present a fully quantum mechanical treatment of the nondegenerate optical parametric oscillator both below and near threshold. This is a nonequilibrium quantum system with a critical point phase transition, that is also known to exhibit strong yet easily observed squeezing and quantum entanglement. Our treatment makes use of the positive P representation and goes beyond the usual linearized theory. We compare our analytical results with numerical simulations and find excellent agreement. We also carry out a detailed comparison of our results with those obtained from stochastic electrodynamics, a theory obtained by truncating the equation of motion for the Wigner function, with a view to locating regions of agreement and disagreement between the two. We calculate commonly used measures of quantum behavior including entanglement, squeezing, and Einstein-Podolsky-Rosen (EPR) correlations as well as higher order tripartite correlations, and show how these are modified as the critical point is approached. These results are compared with those obtained using two degenerate parametric oscillators, and we find that in the near-critical region the nondegenerate oscillator has stronger EPR correlations. In general, the critical fluctuations represent an ultimate limit to the possible entanglement that can be achieved in a nondegenerate parametric oscillator.

Staff and patient perceptions of seclusion: Has anything changed?

Background Seclusion continues to be widely used in the management of disturbed behaviour in hospitalized patients. While early research on the topic highlighted significant differences in staff and patient perceptions, there are few recent data to indicate if these differences still exist. Aim This paper reports a study exploring the perceptions of both nursing staff and patients towards the reasons for seclusion; its effects; patients' feelings during seclusion; and possible changes to the practice. Methods Sixty nursing staff and 29 patients who had experienced seclusion at three inpatient units in Queensland, Australia completed Heyman's Attitudes to Seclusion Survey. Results The findings indicate that the two groups differed significantly on a number of the dimensions assessed. Nurses believed seclusion to be very necessary, not very punitive and a highly therapeutic practice that assisted patients to calm down and feel better. Patients, on the other hand, believed that seclusion was used frequently for minor disturbances and as a means of staff exerting power and control. Patients also believed that seclusion resulted in them feeling punished, and had little therapeutic value. Conclusion The disagreement between staff and patients highlights the need for greater dialogue between these groups. While nursing staff require greater understanding of how patients feel about seclusion, patients require information on why and how seclusion is implemented.

Fetal echocardiography: are we getting it right?

Objective To determine the diagnostic accuracy of prenatal fetal echocardiography. Methods The study was a retrospective chart review of 190 consecutive patients over a 3-year period from November 1998 to February 2002 of all women referred to the Maternal Fetal Medicine unit, Mater Mothers Hospital, for fetal echocardiography. The prenatal diagnosis was compared with the postnatal diagnosis made by postnatal echocardiography, surgical findings or post-mortem. The accuracy of prenatal diagnosis was described on a predetermined 4-point scale. Results Of the 89 patients, for whom complete diagnostic follow-up was available, there was complete agreement between the prenatal and postnatal diagnosis in 63 cases, minor discrepancies in 25 cases and major disagreement in 1 case. Conclusions In experienced hands, fetal echocardiography is accurate and allows medical staff and patients information in order manage a pregnancy appropriately. Copyright (C) 2004 John Wiley Sons, Ltd.

Chemical characterization of earth's most ancient clastic metasediments from the Isua Greenstone Belt, southern West Greenland

New and published major and trace element abundances of elastic metasediments (mainly garnet-biotite-plagioclase schists) from the similar to 3.8 Ga Isua Greenstone Belt (IGB), southern West Greenland, are used in an attempt to identify the compositional characteristics of the protoliths of these sediments. Compositionally, the metasediments are heterogeneous with enrichment of LREE (La/Sm-chord = 1.1-3.9) and variable enrichment and depletion of HREE (Gd/Yb-chord = 0.8-4.3). Chondrite-normalized Eu is also variable, spanning a range from relative Eu depletion to enrichment (Eu/Eu* = 0.6-1.3). A series of geochemical and geological criteria provides conclusive evidence for a sedimentary origin, in disagreement with some previous studies that questioned the presence of genuine elastic metasediments. In particular, trace element systematics of IGB metasediments show strong resemblance to other well-documented Archaean clastic sediments, and are consistent with a provenance consisting of ultramafic, malic and felsic igneous rocks. Two schists, identified as metasomatized mafic igneous rocks from petrographic and field evidence, show distinct compositional differences to the metasediments. Major element systematics document incipient-to-moderate source weathering in the majority of metasediments, while signs of secondary K-addition are rare. Detailed inspection of Eu/Eu*, Fe2O3 and CIW (chemical index of weathering) relationships reveals that elevated iron contents (when compared to averages for continental crust) and strong relative enrichment in Eu may be due to precipitation of marine Fe-oxyhydroxides during deposition or diagenesis on the seafloor. Some of the IGB metasediments have yielded anomalous Nd-142 and W-182 isotopic compositions that were respectively interpreted in terms of early mantle differentiation processes and the presence of a meteorite component. Alternatively, W and possibly Nd isotopes could have been affected by thermal neutron capture on the Hadean surface. The latter process was tested in this study by analysis of Sm isotope compositions, which serve as an effective monitor for neutron capture effects. As no anomalous variation from terrestrial values was detected, we infer that isotope systematics (including W-182 and Nd-142) of IGB metasediments were not affected by neutron capture, but reflect decay of radioactive parent isotopes. Copyright (c) 2005 Elsevier Ltd.

Ten Australian elementary teachers' discourse and reported pedagogical practices during cooperative learning

This article describes the types of discourse 10 Australian grade 4-6 teachers used after they had been trained to embed cooperative learning in their curriculum and to use communication skills to promote students' thinking and to scaffold their learning. One audiotaped classroom social science lesson involving cooperative learning was analyzed for each teacher. We provide vignettes from 2 teachers as they worked with groups and from 2 student groups. The data from the audiotapes showed that the teachers used a range of mediated-learning behaviors in their interactions with the children that included challenging their perspectives, asking more cognitive and metacognitive questions, and scaffolding their learning. In turn, in their interactions with each other, the children modelled many of the types of discourse they heard their teachers use. Follow-up interviews with the teachers revealed that they believed it was important to set expectations for children's group behaviors, teach the social skills students needed to deal with disagreement in groups, and establish group structures so children understood what was required both from each other and the task. The teachers reported that mixed ability and gender groups worked best and that groups should be no larger than 5 students. All teachers' programs were based on a child-centered philosophy that recognized the importance of constructivist approaches to learning and the key role interaction plays in promoting social reasoning and learning.

Chronic hepatitis B: A critical appraisal of current approaches to therapy

Background & Aims: Treatment of chronic hepatitis B (CHB) involves a number of complex and controversial issues. Expert opinions may differ from those of practicing hepatologists and gastroenterologists. We aimed to explore this issue further after a critical review of the literature. Methods: A panel of 14 international experts graded the strength of evidence for 16 statements addressing 3 content areas: patient selection, therapeutic end points, and treatment options. Available data relating to the statements were reviewed critically in 3 small work groups. After discussion of each statement with the entire panel, the experts voted anonymously to accept or reject statements based on the strength of evidence and their experience. A total of 241 members of the American Association for the Study of Liver Diseases (AASLD) responded to the same statements and their responses were compared with those of the experts. A discordant response was defined as a difference of more than 20% in any of the 5 graded levels of response (accept or reject) between the 2 groups. Results: With the exception of 2 statements, the experts’ responses were relatively uniform. However, the responses of the AASLD members were discordant from the experts in 12 statements, spanning all 3 content areas. Conclusions: Several areas of disagreement on the management of CHB exist between experts and AASLD members. Our results indicate a potential knowledge gap among practicing hepatologists. Better educational efforts are needed to meet the challenge of managing this complex disorder in which even expert opinion occasionally may disagree.

Do different surrogate methods detect lateral genetic transfer events of different relative ages?

Non-tree-based ('surrogate') methods have been used to identify instances of lateral genetic transfer in microbial genomes but agreement among predictions of different methods can be poor. It has been proposed that this disagreement arises because different surrogate methods are biased towards the detection of certain types of transfer events. This conjecture is supported by a rigorous phylogenetic analysis of 3776 proteins in Escherichia coli K12 MG1655 to map the ages of transfer events relative to one another.