Cost effectiveness of a multi-stage return to work program for workers on sick leave due to low back pain, design of a population based controlled trial [ISRCTN60233560]

BACKGROUND: To describe the design of a population based randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing participative ergonomics interventions between 2–8 weeks of sick leave and Graded Activity after 8 weeks of sick leave with usual care, in occupational back pain management. METHODS: DESIGN: An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain. Interventions used are 1. Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist. 2. Graded Activity based on cognitive behavioural principles by a physiotherapist. 3. Usual care, provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain. The primary outcome measure is return to work. Secondary outcome measures are pain intensity, functional status and general improvement. Intermediate variables are kinesiophobia and pain coping. The cost-effectiveness analysis includes the direct and indirect costs due to low back pain. The outcome measures are assessed before randomization (after 2–6 weeks on sick leave) and 12 weeks, 26 weeks and 52 weeks after first day of sick leave. DISCUSSION: The combination of these interventions has been subject of earlier research in Canada. The results of the current RCT will: 1. crossvalidate the Canadian findings in an different sociocultural environment; 2. add to the cost-effectiveness on treatment options for workers in the sub acute phase of low back pain. Results might lead to alterations of existing (inter)national guidelines

TGF-ß Sma/Mab Signaling Mutations Uncouple Reproductive Aging from Somatic Aging

Female reproductive cessation is one of the earliest age-related declines humans experience, occurring in mid-adulthood. Similarly, Caenorhabditis elegans' reproductive span is short relative to its total life span, with reproduction ceasing about a third into its 15–20 day adulthood. All of the known mutations and treatments that extend C. elegans' reproductive period also regulate longevity, suggesting that reproductive span is normally linked to life span. C. elegans has two canonical TGF-ß signaling pathways. We recently found that the TGF-ß Dauer pathway regulates longevity through the Insulin/IGF-1 Signaling (IIS) pathway; here we show that this pathway has a moderate effect on reproductive span. By contrast, TGF-ß Sma/Mab signaling mutants exhibit a substantially extended reproductive period, more than doubling reproductive span in some cases. Sma/Mab mutations extend reproductive span disproportionately to life span and act independently of known regulators of somatic aging, such as Insulin/IGF-1 Signaling and Dietary Restriction. This is the first discovery of a pathway that regulates reproductive span independently of longevity and the first identification of the TGF-ß Sma/Mab pathway as a regulator of reproductive aging. Our results suggest that longevity and reproductive span regulation can be uncoupled, although they appear to normally be linked through regulatory pathways

Associated features in females with an FMR1 premutation

Abstract Changes in the fragile X mental retardation 1 gene (FMR1) have been associated with specific phenotypes, most specifically those of fragile X syndrome (FXS), fragile X tremor/ataxia syndrome (FXTAS), and fragile X primary ovarian insufficiency (FXPOI). Evidence of increased risk for additional medical, psychiatric, and cognitive features and conditions is now known to exist for individuals with a premutation, although some features have been more thoroughly studied than others. This review highlights the literature on medical, reproductive, cognitive, and psychiatric features, primarily in females, that have been suggested to be associated with changes in the FMR1 gene. Based on this review, each feature is evaluated with regard to the strength of evidence of association with the premutation. Areas of need for additional focused research and possible intervention strategies are suggested

Amphibian phylogeography: a model for understanding historical aspects of species distributions

Phylogeographic analysis has become a major tool for investigating historical aspects of biogeography and population genetic structure. Anuran amphibians are particularly informative subjects for phylogeographic research on account of their global distribution, high degree of population genetic structure and ease of sampling. Studies on all the world's inhabited continents have demonstrated the nature and locations of refugia, including the Gulf Coast in North America and the Mediterranean peninsulas in Europe during the Pleistocene glaciations; the importance of vicariance events such as the uplift of the Andes in shaping modern distributions; and colonization routes in temperate zones during postglacial climatic amelioration. Features identified as important to amphibian biogeography, notably mountain ranges, large rivers such as the Amazon and climatic fluctuations, are common to many other taxa. New analytical methods based on coalescent, Bayesian and likelihood approaches permit more rigorous hypothesis testing than has hitherto been possible and offer the prospect of even more detailed insights into species and population history in future work

Factors affecting availability for detection: An example using radio-collared Northern Bobwhite (Colinus virginianus)

Avian monitoring strategies are usually linked to bird singing or calling behavior. Individual availability for detection can change as a result of conspecific factors affecting bird behavior, though the magnitude of these effects is difficult to quantify. We evaluated behavioral and temporal factors affecting Northern Bobwhite (Colinus virginianus) breeding season individual availability for detection during three common survey times (3 min, 5 min, 10 min). We conducted 10-minute surveys associated with radio-collared male Northern Bobwhites on Peabody Wildlife Management Area, Kentucky, from 2010-2011. We homed to within 50 m of radio-collared males and recorded number of distinct Northern Bobwhite whistles (singing rate) per 1-minute interval, number of other males calling during the survey, minutes-since-sunrise, and day-of-season. We also recorded the number of minutes during a 10-minute survey that radio-collared male Northern Bobwhites called. We used logistic regression to estimate availability of radio-collared individuals for 3-minute, 5-minute, and 10-minute surveys. We also modeled number of minutes during 10-minute surveys that radio-collared Northern Bobwhites called, and we modeled singing rate. Individual availability for detection of radio-collared individuals during a 10-minute survey increased by 100% when at least 1 other Northern Bobwhite called during a survey (6.5% to 13.1%) and by 626% when 6 other Northern Bobwhites were calling (6.5% to 47.6%). Individual availability was 30% greater for 10-minute surveys than 5-minute surveys or 55% greater for 10-minute surveys than 3-minute surveys. Northern Bobwhite called most (2.8 ± 0.66 minutes/10-min survey) and at a greater rate (11.8 ± 1.3 calls/10-min period) when at least 5 other Northern Bobwhites called. Practitioners risk biasing population estimates low if individual availability is unaccounted for because species with low populations will not be stimulated by other calling males, are less likely to call, call less frequently, and call fewer times per minute, reducing their individual availability and likelihood to be counted on a survey even when they are present