Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis.

BACKGROUND: Lumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically reviewed the current clinical evidence regarding athlete return to sport (RTS) following lumbar discectomy compared to conservative treatment. METHODS: A computer-assisted literature search of MEDLINE, CINAHL, Web of Science, PEDro, OVID and PubMed databases (from inception to August 2015) was utilised using keywords related to lumbar disc herniation and surgery. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality of individual studies was assessed using the Downs and Black scale (0-16 points). RESULTS: The search strategy revealed 14 articles. Downs and Black quality scores were generally low with no articles in this review earning a high-quality rating, only 5 articles earning a moderate quality rating and 9 of the 14 articles earning a low-quality rating. The pooled RTS for surgical intervention of all included studies was 81% (95% CI 76% to 86%) with significant heterogeneity (I(2)=63.4%, p<0.001) although pooled estimates report only 59% RTS at same level. Pooled analysis showed no difference in RTS rate between surgical (84% (95% CI 77% to 90%)) and conservative intervention (76% (95% CI 56% to 92%); p=0.33). CONCLUSIONS: Studies comparing surgical versus conservative treatment found no significant difference between groups regarding RTS. Not all athletes that RTS return at the level of participation they performed at prior to surgery. Owing to the heterogeneity and low methodological quality of included studies, rates of RTS cannot be accurately determined.

How well do midwives use skills and knowledge in examining newborns?

Physical examination of the newborn (PEN) was established as part of postnatal care in the late 1960s. The role of discharging babies within the first 72 hours of birth was traditionally undertaken by junior doctors. Currently midwives, nurses, advanced nurse practitioners, and health visitors are being trained to undertake the PEN (NHS Screening Programmes, 2010). However, only a fraction of midwives utilize their acquired skills in clinical practice. A survey by Townsend et al (2004) showed that 2% of babies in England were examined by midwives while 83% were examined by junior doctors.This study aimed to evaluate how well midwives who undertook the PEN course between 2002 and 2005 (n = 40) at a large London University utilized the skills acquired on the course. Questionnaires with a series of open and closed questions were sent out by post followed by phone and email reminders. The eight that responded were midwives. All respondents said they were appropriately trained and felt well prepared for their role to examine babies. However, they felt they were not provided with opportunities to use the skills. Guidelines based on this extended role are available in the workplace but only a few midwives seemed to have negotiated time to implement these and may need greater managerial support for the role.

Guest sorption and desorption in the metal-organic framework [Co(INA)(2)] (INA = isonicotinate) - evidence of intermediate phases during desorption

The metal-organic framework [Co(INA)(2)].0.5EtOH (INA = isonicotinate, NC5H4-4-CO2-), 1 was synthesised under solvothermal conditions. Its X-ray crystal structure shows channels containing ethanol guests which are hydrogen-bonded to carboxylate oxygens of the framework. The pyridyl rings of the framework alternate between `open' and `closed' positions along the channels resulting in large variation in the channel cross-sectional area from ca. 1.4 by 2.3 at the narrowest point to 4.9 by 5.3 at the widest. Despite the very small windows, the ethanol guests (of van der Waals diameter ca. 4.2-6.1 Angstrom) may be reversibly desorbed and sorbed into the structure quantitatively, as shown by in situ variable-temperture IR spectroscopy and XRPD. The single-crystal structure of the desolvated form [Co(INA)(2)]2 shows that there is no change in the overall connectivity on desolvation, but the rotational positions of the pyridine rings are altered. This suggests that pyridyl rotation may occur to allow guests to pass in and out. When the synthesis was conducted in 1-propanol solvent [Co(INA)(2)].0.5Pr(n)OH.H2O 3, was obtained, and a single-crystal X-ray structure revealed the same overall connectivity as in 1 but with pyridine rings disordered over closed and open positions. There was no evidence of included guests from X-ray crystallography, suggesting that they are also highly disordered. Variable-temperature XRPD performed on bulk samples showed peaks which were unsymmetrical and exhibited shoulders, suggesting that for each pattern obtained the material actually consisted of several closely-related phases. The movements of the peaks during desolvation showed the presence of intermediate phases before the final desolvated product was formed. The peak positions of the intermediate phases matched more closely with the calculated pattern for 3 than with 1 or 2, suggesting that they may have disordered structures similar to 3. The results also suggest that the intermediate phase represents an initial increase in volume before a larger decrease in volume occurs to give the final desolvated material.

Reducing the visual burden of glaucoma in Asia: what we know and what we need to know.

Despite great progress in elucidating risk factors and effective treatments for eye disease in the last decades, blindness prevalence in the developing and developed world is either static or rising. A research agenda is needed to develop and test specific strategies to reduce the burden of blindness from glaucoma and other common eye diseases. Current knowledge about open and closed-angle glaucoma is reviewed and a strategy to reduce glaucoma blindness in Asia is suggested. A critical component of this strategy is enhanced training in the detection of narrow angles and optic nerve damage by direct examination. Specific research topics that could inform such a strategy are outlined.

Closed circuit rebreathing to achieve inert gas wash-in for multiple breath wash-out

Multiple breath wash-out (MBW) testing requires prior wash-in of inert tracer gas. Wash-in efficiency can be enhanced by a rebreathing tracer in a closed circuit. Previous attempts to deploy this did not account for the impact of CO2 accumulation on patients and were unsuccessful. We hypothesised that an effective rebreathe wash-in could be delivered and it would not alter wash-out parameters. Computer modelling was used to assess the impact of the rebreathe method on wash-in efficiency. Clinical testing of open and closed circuit wash-in–wash-out was performed in healthy controls and adult patients with cystic fibrosis (CF) using a circuit with an effective CO2 scrubber and a refined wash-in protocol. Wash-in efficiency was enhanced by rebreathing. There was no difference in mean lung clearance index between the two wash-in methods for controls (6.5 versus 6.4; p=0.2, n=12) or patients with CF (10.9 versus 10.8; p=0.2, n=19). Test time was reduced by rebreathe wash-in (156 versus 230 s for CF patients, p<0.001) and both methods were well tolerated. End wash-in CO2 was maintained below 2% in most cases. Rebreathe–wash-in is a promising development that, when correctly deployed, reduces wash-in time and facilitates portable MBW testing. For mild CF, wash-out outcomes are equivalent to an open circuit.

Invisible cities: the table of contents and the labyrinths of reality

In Invisible Cities (1972), Italo Calvino contrasts a rigid outline structure with a flexible textual content. The tension comprised by the numerical structure proposed in the table of contents stands out against the set of polissemic texts which make up the subject matter of the book. The opposition between form and content point to a fruitful dichotomy in the conception of the novel linked to the theories of the open and closed work. This essay will investigate the structural construction of Invisible Cities by looking at its table of contents, seeking to discuss some models of formalistic representation proposed by the criticism and the specific contribution they may, or may not, provide. The objective is to analyse the pertinence of such theories in the light of historical and cultural approaches. Aiming to uncover possible meanings which arise from the debate, this essay will question to what extent structural complexities can be considered literary if they are not ultimately related to the culture in which a text is found.

The Experience of Treatment of Persons Presenting with Concomitant Psychotic and Borderline Personality Disorders

Essai doctoral présenté à la Faculté des arts et des sciences en vue de l'obtention du grade de doctorat en psychologie (D.Psy.) option psychologie clinique

Optimizing Robust Quantum Gates in Open Quantum Systems

We are currently at the cusp of a revolution in quantum technology that relies not just on the passive use of quantum effects, but on their active control. At the forefront of this revolution is the implementation of a quantum computer. Encoding information in quantum states as “qubits” allows to use entanglement and quantum superposition to perform calculations that are infeasible on classical computers. The fundamental challenge in the realization of quantum computers is to avoid decoherence – the loss of quantum properties – due to unwanted interaction with the environment. This thesis addresses the problem of implementing entangling two-qubit quantum gates that are robust with respect to both decoherence and classical noise. It covers three aspects: the use of efficient numerical tools for the simulation and optimal control of open and closed quantum systems, the role of advanced optimization functionals in facilitating robustness, and the application of these techniques to two of the leading implementations of quantum computation, trapped atoms and superconducting circuits. After a review of the theoretical and numerical foundations, the central part of the thesis starts with the idea of using ensemble optimization to achieve robustness with respect to both classical fluctuations in the system parameters, and decoherence. For the example of a controlled phasegate implemented with trapped Rydberg atoms, this approach is demonstrated to yield a gate that is at least one order of magnitude more robust than the best known analytic scheme. Moreover this robustness is maintained even for gate durations significantly shorter than those obtained in the analytic scheme. Superconducting circuits are a particularly promising architecture for the implementation of a quantum computer. Their flexibility is demonstrated by performing optimizations for both diagonal and non-diagonal quantum gates. In order to achieve robustness with respect to decoherence, it is essential to implement quantum gates in the shortest possible amount of time. This may be facilitated by using an optimization functional that targets an arbitrary perfect entangler, based on a geometric theory of two-qubit gates. For the example of superconducting qubits, it is shown that this approach leads to significantly shorter gate durations, higher fidelities, and faster convergence than the optimization towards specific two-qubit gates. Performing optimization in Liouville space in order to properly take into account decoherence poses significant numerical challenges, as the dimension scales quadratically compared to Hilbert space. However, it can be shown that for a unitary target, the optimization only requires propagation of at most three states, instead of a full basis of Liouville space. Both for the example of trapped Rydberg atoms, and for superconducting qubits, the successful optimization of quantum gates is demonstrated, at a significantly reduced numerical cost than was previously thought possible. Together, the results of this thesis point towards a comprehensive framework for the optimization of robust quantum gates, paving the way for the future realization of quantum computers.

The structural component of linguistic meaning and the reading of normally hearing and deaf children

This paper discusses an experiment in psycholinguistic method and its application to the field of education.

The use of agricultural, open and forest habitats by juvenile Mauritius Kestrels Falco punctatus

Knowledge of tropical raptor habitat use is limited and yet a thorough understanding is vital when trying to conserve endangered species. We used a well studied, reintroduced population of the vulnerable Mauritius Kestrel Falco punctatus to investigate habitat preferences in a modified landscape. We constructed a high resolution digital habitat map and radiotracked 13 juvenile Kestrels to quantify habitat preferences. We distinguished seven habitat types in our study area and tracked Kestrels from 71 to 130 days old during which they dispersed from their natal territory and settled within a home-range after reaching independence. Mean home-range size was 0.95 km(2) characterized by a bimodal pattern of intensity around the natal site and post-independence home-range. Compositional analysis showed that home-ranges were located non-randomly with respect to habitat but there was no evidence to suggest differential use of habitats within home-ranges. Native and semi-invaded forest and grassland were consistently preferred, whereas agriculture was used significantly less than other habitats. No difference was found between the available length of edge dividing native forest and grassland within a home-range when compared to that available within a 2.35-km buffer around their nest-site, based on the maximum distance a juvenile was found to disperse. Repeating the analysis in three dimensions gave very similar results. Our results suggest that Mauritius Kestrels are not obligate forest dwellers as was once thought but can also exploit open habitats such as grassland. Kestrels may be using isolated mature trees within grassland as vantage points for hunting in the same way as they use the natural stratified forest structure. We suggest that the avoidance of agriculture is partly due to a lack of such vantage points. The conservation importance of forest degradation and agricultural encroachment is highlighted and comparisons with the habitat preferences of other tropical falcons are discussed.

The coupled δ13C-radiocarbon systematics of three Late Glacial/early Holocene speleothems: insights into soil and caveprocesses at climatic transitions

The coupled δ13C-radiocarbon systematics of threeEuropean stalagmites deposited during the Late Glacial and early Holocene were investigated to understand better how the carbon isotope systematics of speleothems respond to climate transitions. The emphasis is on understanding how speleothems may record climate-driven changes in the proportions of biogenic (soil carbon) and limestone bedrock derived carbon. At two of the three sites, the combined δ13C and 14C data argue against greater inputs of limestone carbon as the sole cause of the observed shift to higher δ13C during the cold Younger Dryas. In these stalagmites (GAR-01 from La Garma cave, N. Spain and So-1 from Sofular cave, Turkey), the combined changes in δ13C and initial 14C activities suggest enhanced decomposition of old stored, more recalcitrant, soil carbon at the onset of the warmer early Holocene. Alternative explanations involving gradual temporal changes between open- and closed-system behaviour during the Late Glacial are difficult to reconcile with observed changes in speleothem δ13C and the growth rates. In contrast, a stalagmite from Pindal cave (N. Spain) indicates an abrupt change in carbon inputs linked to local hydrological and disequilibrium isotope fractionation effects, rather than climate change. For the first time, it is shown that while the initial 14C activities of all three stalagmites broadly follow the contemporaneous atmospheric 14C trends (the Younger Dryas atmospheric 14C anomaly can be clearly discerned), subtle changes in speleothem initial 14C activities are linked to climate-driven changes in soil carbon turnover at a climate transition.

Knowledge and perception of Ghanaian cocoa farmers on mirid control and their willingness to use forecasting systems

Annual losses of cocoa in Ghana to mirids are significant. Therefore, accurate timing of insecticide application is critical to enhance yields. However, cocoa farmers often lack information on the expected mirid population for each season to enable them to optimise pesticide use. This study assessed farmers’ knowledge and perceptions of mirid control and their willingness to use forecasting systems informing them of expected mirid peaks and time of application of pesticides. A total of 280 farmers were interviewed in the Eastern and Ashanti regions of Ghana with a structured open and closed ended questionnaire. Most farmers (87%) considered mirids as the most important insect pest on cocoa with 47% of them attributing 30-40% annual crop loss to mirid damage. There was wide variation in the timing of insecticide application as a result of farmers using different sources of information to guide the start of application. The majority of farmers (56%) do not have access to information on the type, frequency and timing of insecticides to use. However, respondents who are members of farmer groups had better access to such information. Extension officers were the preferred channel for information transfer to farmers with 72% of farmers preferring them to other available methods of communication. Almost all the respondents (99%) saw the need for a comprehensive forecasting system to help farmers manage cocoa mirids. The importance of accurate timing for mirid control based on forecasted information to farmer groups and extension officers was discussed.