Cognitive-behavioural treatment for subacute and chronic neck pain

BACKGROUND: Although research on non-surgical treatments for neck pain (NP) is progressing, there remains uncertainty about the efficacy of cognitive-behavioural therapy (CBT) for this population. Addressing cognitive and behavioural factors might reduce the clinical burden and the costs of NP in society.OBJECTIVES: To assess the effects of CBT among individuals with subacute and chronic NP. Specifically, the following comparisons were investigated: (1) cognitive-behavioural therapy versus placebo, no treatment, or waiting list controls; (2) cognitive-behavioural therapy versus other types of interventions; (3) cognitive-behavioural therapy in addition to another intervention (e.g. physiotherapy) versus the other intervention alone.SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, Web of Science, and PubMed, as well as ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to November 2014. Reference lists and citations of identified trials and relevant systematic reviews were screened.SELECTION CRITERIA: We included randomised controlled trials that assessed the use of CBT in adults with subacute and chronic NP.DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risk of bias in each study and extracted the data. If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was performed. We determined the quality of the evidence for each comparison with the GRADE approach.MAIN RESULTS: We included 10 randomised trials (836 participants) in this review. Four trials (40%) had low risk of bias, the remaining 60% of trials had a high risk of bias.The quality of the evidence for the effects of CBT on patients with chronic NP was from very low to moderate. There was low quality evidence that CBT was better than no treatment for improving pain (standard mean difference (SMD) -0.58, 95% confidence interval (CI) -1.01 to -0.16), disability (SMD -0.61, 95% CI -1.21 to -0.01), and quality of life (SMD -0.93, 95% CI -1.54 to -0.31) at short-term follow-up, while there was from very low to low quality evidence of no effect on various psychological indicators at short-term follow-up. Both at short- and intermediate-term follow-up, CBT did not affect pain (SMD -0.06, 95% CI -0.33 to 0.21, low quality, at short-term follow-up; MD -0.89, 95% CI -2.73 to 0.94, low quality, at intermediate-term follow-up) or disability (SMD -0.10, 95% CI -0.40 to 0.20, moderate quality, at short-term follow-up; SMD -0.24, 95% CI-0.54 to 0.07, moderate quality, at intermediate-term follow-up) compared to other types of interventions. There was moderate quality evidence that CBT was better than other interventions for improving kinesiophobia at intermediate-term follow-up (SMD -0.39, 95% CI -0.69 to -0.08, I(2) = 0%). Finally, there was very low quality evidence that CBT in addition to another intervention did not differ from the other intervention alone in terms of effect on pain (SMD -0.36, 95% CI -0.73 to 0.02) and disability (SMD -0.10, 95% CI -0.56 to 0.36) at short-term follow-up.For patients with subacute NP, there was low quality evidence that CBT was better than other interventions at reducing pain at short-term follow-up (SMD -0.24, 95% CI -0.48 to 0.00), while no difference was found in terms of effect on disability (SMD -0.12, 95% CI -0.36 to 0.12) and kinesiophobia.None of the included studies reported on adverse effects.AUTHORS' CONCLUSIONS: With regard to chronic neck pain, CBT was found to be statistically significantly more effective for short-term pain reduction only when compared to no treatment, but these effects could not be considered clinically meaningful. When comparing both CBT to other types of interventions and CBT in addition to another intervention to the other intervention alone, no differences were found. For patients with subacute NP, CBT was significantly better than other types of interventions at reducing pain at short-term follow-up, while no difference was found for disability and kinesiophobia. Further research is recommended to investigate the long-term benefits and risks of CBT including for the different subgroups of subjects with N

Preparation of aluminum oxide nanoparticles with different morphologies

Nanoparticles Al[2]O[3] plays a crucial role in application for drug delivery systems. This study are shown that nanospray method offers significant benefits to produce nanopowder from nitrate aluminum and sulfate aluminum with unique characteristic such as size, morphology and properties for using as drug carriers. Nanopowder from nitrate with a temperature velocity 3 K/min have specific surface area 8.96±0.03 m{2}/gr and 24.04±0.14 m{2}/gr for velocity 6 K/min. Particles size of these materials between 100 nm to 1 [mu]m

A Provably Efficient Option-Based Algorithm for both High-Level and Low-Level Learning

Hierarchical Reinforcement Learning (HRL) approaches have shown successful results in solving a large variety of complex, structured, long-horizon problems. Nevertheless, a full theoretical understanding of this empirical evidence is currently missing. In the context of the option framework, prior research has devised efficient algorithms for scenarios where options are fixed, and the high-level policy selecting among options only has to be learned. However, the fully realistic scenario in which both the high-level and the low-level policies are learned is surprisingly disregarded from a theoretical perspective. This work makes a step towards the understanding of this latter scenario. Focusing on the finite-horizon problem, we present a meta-algorithm alternating between regret minimization algorithms instanced at different (high and low) temporal abstractions. At the higher level, we treat the problem as a Semi-Markov Decision Process (SMDP), with fixed low-level policies, while at a lower level, inner option policies are learned with a fixed high-level policy. The bounds derived are compared with the lower bound for non-hierarchical finitehorizon problems, allowing to characterize when a hierarchical approach is provably preferable, even without pre-trained options

Programmable System on Chip for controlling an atomic physics experiment

Most atomic physics experiments are controlled by a digital pattern generator used to synchronize all equipment by providing triggers and clocks. Recently, the availability of well-documented open-source development tools has lifted the barriers to using programmable systems on chip (PSoC), making them a convenient and versatile tool for synthesizing digital patterns. Here, we take advantage of these advancements in the design of a versatile clock and pattern generator using a PSoC. We present our design with the intent of highlighting the new possibilities that PSoCs have to offer in terms of flexibility. We provide a robust hardware carrier and basic firmware implementation that can be expanded and modified for other uses

Fit for what?: towards explaining Battlegroup inaction

The thrust of this paper concerns the case of the European Battlegroup (BG) non-deployment in late 2008, when the United Nations requested European military support for the United Nations Organisation Mission peacekeeping force in the Democratic Republic of the Congo (DRC). The argument is built on the fact that when, in official documents, the EU approaches the European security and ESDP/CSDP's military crisis management policy and interventions, it makes strong references to the United Nations and the UN Charter Chapter VII's mandate of restoring international peace and security. Such references make it seem that supporting the UN when it deals with threats and crises is a primary concern of the EU and the member states. These allusions lead to the main contention of this paper, that there is much ambivalence in these indications. The paper develops its argument from one key hypothesis; namely, that the non-deployment of a European BG in the DRC, at the end of 2008, constitutes a useful case study for detecting a number of ambiguities of the EU in respect of its declarations in the official documents establishing the European military crisis management intervention structure

Analysis of errors in histology by root cause analysis: a pilot study

Introduction. The study objective is to evaluate critical points in the process of pre-analytical histology in an Anatomic Pathology laboratory. Errors are an integral part of human systems, includ- ing the complex system of Anatomic Pathology. Previous studies focused on errors committed in diagnosis and did not consider the issues related to the histology preparation of routine processes. Methods. Root Cause Analysis was applied to the process of histology preparation in order to identify the root cause of each previously identified problem. The analysis started by defining an ?a priori? list of errors that could occur in the histology prepara- tion processes. During a three-month period, a trained technician tracked the errors encountered during the process and reported them on a form. ?Fishbone? diagram and ?Five whys? methods were then applied. Results. 8,346 histological cases were reviewed, for which 19,774 samples were made and from which 29,956 histologies were pre- pared. 132 errors were identified. Errors were detected in each phase: accessioning (6.5%), gross dissecting (28%), processing (1.5%), embedding (4.5%), tissue cutting and slide mounting (23%), coloring, (1.5%), labeling and releasing (35%). Discussion. Root cause analysis is effective and easy to use in clinical risk management. It is an important step for the identifi- cation and prevention of errors, that are frequently due to multi- ple causes. Developing operators? awareness of their central role in the risk management process is possible by targeted training. Furthermore, by highlighting the most relevant points of interest, it is possible to improve both the methodology and the procedural safety