An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management

Objectives: Failed back surgery syndrome (FBSS) patients experience pain, functional disability, and reduced health-related quality of life (HRQoL) despite anatomically successful surgery. Examining sub-dimensions of health outcomes measures provides insight into patient well-being. Materials and Methods: The international multicenter PROCESS trial collected detailed HRQoL (EuroQol-5D; Short-Form 36) and function (Oswestry Disability Index) information on 100 FBSS patients. Results: At baseline, patients reported moderate-to-severe leg and back pain adversely affecting all dimensions of function and HRQoL. Compared with conventional medical management alone, patients also receiving spinal cord stimulation (SCS) reported superior pain relief, function, and HRQoL at six months on overall and most sub-component scores. The majority of these improvements with SCS were sustained at 24 months. Nonetheless, 36-40% of patients experienced ongoing marked disability (standing, lifting) and HRQoL problems (pain/discomfort). Conclusions: Longer-term patient management and research must focus on these refractory FBSS patients with persisting poor function and HRQoL outcomes.

Engagement Plan: Review of AHP Support for Children with Statements of Special Educational Needs in Special Schools and Mainstream Education

This engagement plan outlines the collaborative and partnership approach with key stakeholders in the first phase of the Review of AHP Support for Children with Statements of Special Educational Needs in Special Schools and Mainstream Education. It provides detail on how communication objectives will be met.It gives information on:Stakeholder Analysis for Phase One of the ReviewMembership of the Project BoardMembership of the Professional Stakeholder Reference Group

Project Initiation Document Phase One: Scoping Exercise within special schools

This Project Initiation Document outlines the purpose and plan of Phase One of the Review of AHP Support for Children with Statements of Special Educational Needs in Special Schools and Mainstream Education.

Terms of Reference for Project: Review of AHP Support for Children with Statements of Special Educational Needs in Special Schools and Mainstream Education

This is the Terms of Reference for the review of Allied Health Professional (AHP) support for children/young people with statements of special educational needs.It outlines expectations of the review and should be read in conjunction with the Project Initiation Document (PID) for Phase 1of the review, the Terms of Reference for the Project Board and the Engagement Plan for phase 1.

Terms of reference for Project Board: Review of AHP Support for Children with Statements of Special Educational Needs in Special Schools and Mainstream Education

This is the Terms of Reference for the Project Board of the review of Allied Health Professions (AHP) support for children/young people with statements of special educational needs.It outlines the:Purpose of the Project BoardResponsibilities of the Project BoardMembership of the Project Board

Teeth matter! Caring for your children's teeth: advice for parents and carers of children with special needs

This booklet explains how to care for the teeth of children with special needs.

Extensive remodeling of DC function by rapid maturation-induced transcriptional silencing.

The activation, or maturation, of dendritic cells (DCs) is crucial for the initiation of adaptive T-cell mediated immune responses. Research on the molecular mechanisms implicated in DC maturation has focused primarily on inducible gene-expression events promoting the acquisition of new functions, such as cytokine production and enhanced T-cell-stimulatory capacity. In contrast, mechanisms that modulate DC function by inducing widespread gene-silencing remain poorly understood. Yet the termination of key functions is known to be critical for the function of activated DCs. Genome-wide analysis of activation-induced histone deacetylation, combined with genome-wide quantification of activation-induced silencing of nascent transcription, led us to identify a novel inducible transcriptional-repression pathway that makes major contributions to the DC-maturation process. This silencing response is a rapid primary event distinct from repression mechanisms known to operate at later stages of DC maturation. The repressed genes function in pivotal processes--including antigen-presentation, extracellular signal detection, intracellular signal transduction and lipid-mediator biosynthesis--underscoring the central contribution of the silencing mechanism to rapid reshaping of DC function. Interestingly, promoters of the repressed genes exhibit a surprisingly high frequency of PU.1-occupied sites, suggesting a novel role for this lineage-specific transcription factor in marking genes poised for inducible repression.

Phase 2 Parent/Carer Questionnaire: Review of Allied Health Professions��' (AHP) support for children/young people with a statement of special educational needs

We want to know what you think about the AHP services for your child. We will also seek views of AHPs and teachers who work with your children and we will use them all to inform our decisions. This phase of the review is focusing on current AHP services for children/young people with a statement of special educational needs enrolled in mainstream schools and learning support centres/units attached to a mainstream school.

Review of AHP Support for Children with Statements of Special Educational Needs in Special Schools and Mainstream Education: Phase 2 Engagement Plan

This engagement plan outlines the collaborative and partnership approach with key stakeholders in the second phase of the Review of AHP Support for Children with Statements of Special Educational Needs in Special Schools and Mainstream Education. It provides detail on how communication objectives will be met. It gives information on: Stakeholder Analysis for Phase Two of the Review Membership of the Project Board Membership of the Professional Stakeholder Reference Group

Summary Interim Report on Findings and Interim Themes from Phase 1 of the review of Allied Health Professions (AHP) support for children/young people with a statement of special educational needs (SEN)

Summary Interim Report on Findings and Interim Themes from Phase 1 of the review of Allied Health Professions (AHP) support for children/young people with a statement of special educational needs (SEN)This interim report is outlining the service principles agreed by the Project Board and the themes identified throughout engagement and information gathering.

Effects of dietary protein type on oxidized cholesterol-induced alteration in age-related modulation of lipid metabolism and indices of immune function in rats.

Exogenous oxidized cholesterol disturbs both lipid metabolism and immune functions. Therefore, it may perturb these modulations with ageing. Effects of the dietary protein type on oxidized cholesterol-induced modulations of age-related changes in lipid metabolism and immune function was examined using differently aged (4 weeks versus 8 months) male Sprague-Dawley rats when casein, soybean protein or milk whey protein isolate (WPI) was the dietary protein source, respectively. The rats were given one of the three proteins in diet containing 0.2% oxidized cholesterols mixture. Soybean protein, as compared with the other two proteins, significantly lowered both the serum thiobarbituric acid reactive substances value and cholesterol, whereas it elevated the ratio of high density lipoprotein-cholesterol/cholesterol in young rats, but not in adult. Moreover, soybean protein, but not casein and WPI, suppressed the elevation of Delta6 desaturation indices of phospholipids in both liver and spleen, particularly in young. On the other hand, WPI, compared to the other two proteins, inhibited the leukotriene B4 production of spleen, irrespective of age. Soybean protein reduced the ratio of CD4(+)/CD8(+) T-cells in splenic lymphocytes. Therefore, the levels of immunoglobulin (Ig)A, IgE and IgG in serum were lowered in rats given soybean protein in both age groups except for IgA in adult, although these observations were not shown in rats given other proteins. Thus, various perturbations of lipid metabolism and immune function caused by oxidized cholesterol were modified depending on the type of dietary protein. The moderation by soybean protein on the change of lipid metabolism seems to be susceptible in young rats whose homeostatic ability is immature. These observations may be exerted through both the promotion of oxidized cholesterol excretion to feces and the change of hormonal release, while WPI may suppress the disturbance of immune function by oxidized cholesterol in both ages. This alleviation may be associated with a large amount of lactoglobulin in WPI. These results thus showed a possibility that oxidized cholesterol-induced perturbations of age-related changes of lipid metabolism and immune function can be moderated by both the selection and combination of dietary protein.

Reconstituted human polyclonal plasma-derived secretory-like IgM and IgA maintain the barrier function of epithelial cells infected with an enteropathogen.

Intravenous administration of polyclonal and monoclonal antibodies has proven to be a clinically valid approach in the treatment, or at least relief, of many acute and chronic pathologies, such as infection, immunodeficiency, and a broad range of autoimmune conditions. Plasma-derived IgG or recombinant IgG are most frequently used for intravenous or subcutaneous administration, whereas a few IgM-based products are available as well. We have established recently that secretory-like IgA and IgM can be produced upon association of plasma-derived polymeric IgA and IgM with a recombinant secretory component. As a next step toward potential future mucosal administration, we sought to unravel the mechanisms by which these secretory Igs protect epithelial cells located at the interface between the environment and the inside of the body. By using polarized epithelial Caco-2 cell monolayers and Shigella flexneri as a model enteropathogen, we found that polyspecific plasma-derived SIgA and SIgM fulfill many protective functions, including dose-dependent recognition of the antigen via formation of aggregated immune complexes, reduction of bacterial infectivity, maintenance of epithelial cell integrity, and inhibition of proinflammatory cytokine/chemokine production by epithelial cells. In this in vitro model devoid of other cellular or molecular interfering partners, IgM and secretory IgM showed stronger bacterial neutralization than secretory IgA. Together, these data suggest that mucosally delivered antibody preparations may be most effective when combining both secretory-like IgA and IgM, which, together, play a crucial role in preserving several levels of epithelial cell integrity.