1,708 research outputs found
Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the Arm Pain Trial)
No full textBackground
Upper limb pain is a common cause of disability, demand for health care and lost work time. It is more likely to become persistent if it is accompanied by poor mental health, tendency to somatise, and negative beliefs concerning health and activity. Consequently response to treatment may vary between subgroups defined by such characteristics. Distal upper limb pain (affecting the elbow, forearm, wrist, or hand) can result from several specific musculoskeletal disorders, or be non-specific. Although it is clinically important and costly, the best approach to its clinical management is unclear. Physiotherapy and advice to rest and avoid strenuous activities are often given, but there is no evidence base to support these strategies. Indeed, consistent with evidence on back pain, advice to rest the painful limb may even be inferior to advice to remain active. The purpose of this randomised controlled trial is therefore to explore whether in patients awaiting physiotherapy for distal upper limb pain, advice to maintain activities produces a long-term reduction of symptoms and disability compared with advice to rest. The pragmatic nature of this trial also provides an opportunity to test whether immediate physiotherapy is more beneficial than physiotherapy received after the normal waiting time. Currently waiting times vary between centres, and over time, but 7-10 weeks is not uncommon.
Methods / Design
555 patients with distal upper limb pain are being recruited from out-patient physiotherapy departments and randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Interventions are of 6 weeks duration, after which physiotherapy is offered to the two advice groups at the time it would normally be received. Patients are assessed at baseline and followed up at 6, 13, and 26 weeks post-randomisation by self-completed postal questionnaire. The primary outcome is the proportion of patients free of disability at the 26 week time point, as determined by the modified-DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. A secondary outcome for patients randomised to the two advice groups is the proportion who seek physiotherapy at 6 weeks. Other secondary outcomes include upper limb pain and function, coping, fear of movement, ability to function at work, and aspects of general health and quality of life.
Analysis
We hypothesise (a) that patients who are advised to maintain usual activities while waiting to receive physiotherapy will experience long-term improvements in function compared to those advised to rest the arm; and (b) patients who receive fast-track physiotherapy will experience long-term improvements in function compared to those who receive physiotherapy at the normal time. These hypotheses will be examined using an intention-to-treat analysis.
Discussion
Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms
Current Evidence of Anti-TNF alpha Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta-Analysis Approach Comparing the Different Drugs
No full textEvaluation of work-related psychosocial factors and regional musculoskeletal pain: results from a EULAR Task Force
No full textObjectives: to establish whether review articles provide consistent conclusions on associations between workplace psychosocial factors and musculoskeletal pain and, if differences exist, to explore whether this is related to the methods used.Methods: reviews, reported up to February 2007, that included consideration of workplace psychosocial factors and upper limb, back or knee pain were identified through searches of multiple databases. The specific work-related psychosocial factors considered were job demands, support, job autonomy and job satisfaction. The conclusions of each review on one or more of the psychosocial/musculoskeletal pain associations were extracted.Results: 15 review articles were identified that considered one or more of the regional pain syndromes included in the study. For back pain, the most consistent conclusions (four reviews positive out of six) were with high job demands and low job satisfaction. The studies of upper limb pain were exclusively related to shoulder and/or neck pain, and the most consistent positive conclusions were with high and low job demands (four reviews positive out of six and two reviews positive out of three, respectively). For knee pain, only a single review was identified. For individual reviews of back and upper limb pain, there were marked differences in the number of associations concluded to be positive between reviews.Conclusions: the reasons for reviews coming to different conclusions included that they were often evaluating different bodies of evidence (according to their search criteria, the year when the review was conducted, the role that quality assessment played in whether studies contributed to evidence, and the combination of risk factors addressed in individual studies), but more important was whether the review specified explicit criteria for making conclusions on strength of evidence. These conclusions emphasise the importance of developing standardised methods for conducting such evaluations of existing evidence and the importance of new longitudinal studies for clarifying the temporal relationship between psychosocial factors and musculoskeletal pain in the workplac
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GJ 3929: High-precision Photometric and Doppler Characterization of an Exo-Venus and Its Hot, Mini-Neptune-mass Companion
No full textWe detail the follow-up and characterization of a transiting exo-Venus identified by TESS, GJ 3929b (TOI-2013b), and its nontransiting companion planet, GJ 3929c (TOI-2013c). GJ 3929b is an Earth-sized exoplanet in its star’s Venus zone (P b = 2.616272 ± 0.000005 days; Sb = 17.3 − 0.7 + 0.8 S ⊕) orbiting a nearby M dwarf. GJ 3929c is most likely a nontransiting sub-Neptune. Using the new, ultraprecise NEID spectrometer on the WIYN 3.5 m Telescope at Kitt Peak National Observatory, we are able to modify the mass constraints of planet b reported in previous works and consequently improve the significance of the mass measurement to almost 4σ confidence (M b = 1.75 ± 0.45 M ⊕). We further adjust the orbital period of planet c from its alias at 14.30 ± 0.03 days to the likely true period of 15.04 ± 0.03 days, and we adjust its minimum mass to m sin i = 5.71 ± 0.92 M ⊕. Using the diffuser-assisted ARCTIC imager on the ARC 3.5 m telescope at Apache Point Observatory, in addition to publicly available TESS and LCOGT photometry, we are able to constrain the radius of planet b to R p = 1.09 ± 0.04 R ⊕. GJ 3929b is a top candidate for transmission spectroscopy in its size regime (TSM = 14 ± 4), and future atmospheric studies of GJ 3929b stand to shed light on the nature of small planets orbiting M dwarfs. © 2022. The Author(s). Published by the American Astronomical Society.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
Insecure attachment style is associated with chronic widespread pain
No full textIndividuals with "insecure" adult attachment styles have been shown to experience more pain than people with secure attachment, though results of previous studies have been inconsistent. We performed a cross-sectional study on a large population-based sample to investigate whether, compared to pain free individuals, subjects with chronic widespread pain were more likely to report insecure adult attachment style. Subjects in a population-based cross-sectional study completed a self-rated assessment of adult attachment style. Attachment style was categorised as secure (i.e., normal attachment style); or preoccupied, dismissing or fearful (insecure attachment styles). Subjects completed a pain questionnaire from which three groups were identified: pain free; chronic widespread pain; and other pain. Subjects rated their pain intensity and pain-related disability on an 11 point Likert scale. Subjects (2509) returned a completed questionnaire (median age 49.9 years (IQR 41.2-50.0); 59.2% female). Subjects with CWP were more likely to report a preoccupied (RRR 2.6; 95%CI 1.8-3.7), dismissing (RRR 1.9; 95%CI 1.2-3.1) or fearful attachment style (RRR 1.4; 95%CI 1.1-1.8) than those free of pain. Among CWP subjects, insecure attachment style was associated with number of pain sites (Dismissing: RRR 2.8; 95%CI 1.2-2.3, Preoccupied: RRR=1.8, 95%CI 0.98-3.5) and degree of pain-related disability (Preoccupied: RRR=2.1, 95%CI 1.0-4.1), but not pain intensity. These findings suggest that treatment strategies based on knowledge of attachment style, possibly using support and education, may alleviate distress and disability in people at risk of, or affected by, chronic widespread pain
The Optimization of the Performance Management for Operators in GJ Company Xiamen
No full text本文以绩效管理的基本理论和GJ厦门厂的实际情况为基础，分析了GJ厦门厂一线作业员绩效管理的问题点，并结合公司目前的实际情况提出一线作业员的绩效管理改善方案。该方案以平衡计分卡的绩效管理体系为逻辑，将公司的战略目标分解到制造处，再分解至一线作业员，让作业员的绩效也能从财务面、客户面、内部运营面、学习成长面四个维度上对公司的战略发展起到支撑作用，以促进组织战略目标的实现。 在绩效管理改进方案中，作者特别强调沟通在绩效管理过程中的重要作用，它贯穿了绩效管理的整个过程。沟通有助于促进员工个人绩效的提升和员工个人的成长，从而提升组织的整体效益。 根据GJ厦门厂的实际情况，将一线作业员的绩效考核结...In this paper, operators’ performance management problems in GJ Company are analyzed based on the basic theory of performance management and the real situation of the company. The author propose to break down the company’s strategic targets to lower levels with balanced scorecard system by four levels of financial, customer, internal operation, learning and developing. So that operators’ performa...学位：管理学硕士院系专业：管理学院_工商管理硕士(工商管理硕士)学号：1792012115103
Dramatic reduction in triplet and higher order births in England and Wales.
No full textThe proportion of multiple births has increased markedly since 1980 in England and Wales. A major contribution to this trend is thought to be the widespread introduction of assisted reproductive technologies. Despite a continuing (but slower) upward trend in twin maternities, analysis of recent data shows that the rate of triplet and higher order births in England and Wales has declined by one-quarter since 1998. This probably reflects both voluntary and statutory regulation of treatment regimes. This downward trend will help alleviate the high burden of perinatal morbidity and mortality associated with multiple births
Exergy comparison of lunar propellant manufacturing and insertion into LEO using a fully reusable refueling rocket
No full textQuantifying the exergy requirement of propellant insertion into LEO can lead to insight into the feasibility of a lunar propellant-generating architecture. Spacecraft leaving from Earth can greatly reduce their lift-off mass if in-space refueling would possible. Exergy analyses quantify the available energy of a system and show where a reduction in usable energy occurs. Insight into the exergy destruction and input provides a key parameter into the scaling and design of processes and corresponding power systems. The present study aims to define an exergy environment in the lunar PSRs and then to analyze the exergy destruction related to the production of oxygen, ALICE, and hydrolox, in terms of both manufacturing and transportation using a two-stage fully reusable rocket. Extraction processes for ALICE and hydrolox were selected and analyzed w.r.t. the lunar environment to get an understanding of the exergy input. The behavior and exergy requirements of an LEO propellant depot was described. Two fully reusable two-stage rockets using ALICE and hydrolox were designed and compared based on their payload-to-propellant ratio for the oxygen, ALICE, and hydrolox payloads. The study found that the exergetic cost for the insertion of oxygen, hydrolox, and ALICE in LEO were 1.32 GJ/kg , 1.64 GJ/kg, and GJ/kg and 23.3 GJ/kg, 23.4 GJ/kg and 26.9 GJ/kg for the hydrolox and ALICE rocket, respectively.Aerospace Engineerin
Experience of miscarriage in the UK: qualitative findings from the National Women's Health Study.
No full textMiscarriage is the most common adverse outcome in pregnancy. For many women it is a traumatic experience. Previous research has identified shortcomings in the emotional and social support provided for miscarriage sufferers but personal accounts of pregnancy loss remain relatively under-explored. The UK National Women's Health Study (NWHS) is a nationally representative survey of women's reproductive histories. It provided an opportunity to study accounts of miscarriage written in response to an invitation for further comments on the survey questionnaire. In conjunction with quantitative findings from the NWHS, we thematically analysed 172 detailed narratives that facilitated qualitative exploration of a characteristically private event. Analysis of the narratives suggested that few women who had planned their pregnancy were satisfied with fatalistic explanations of miscarriage. Those who were not given medical explanations for their loss engaged in complex searches for meaning, often linked to accounts of their moral deservedness as mothers. The narratives highlighted tensions between biomedical and lay understandings of pregnancy loss. There were reports of inappropriate medicalisation and a perceived lack of emotional support, but also a desire for medical validation of the reality of miscarriage and investigations to identify medical causes. Professionals' reported behaviour played a key role in women's accounts. These findings remind providers that: women do not experience miscarriage as a routine complication; medicalisation is both resisted and desired; and, for some women, more support and information is needed to assist their search for meaning
Self-reported ill health in male UK Gulf War veterans: a retrospective cohort study.
No full textBACKGROUND: Forces deployed to the first Gulf War report more ill health than veterans who did not serve there. Many studies of post-Gulf morbidity are based on relatively small sample sizes and selection bias is often a concern. In a setting where selection bias relating to the ill health of veterans may be reduced, we: i) examined self-reported adult ill health in a large sample of male UK Gulf War veterans and a demographically similar non-deployed comparison group; and ii) explored self-reported ill health among veterans who believed that they had Gulf War syndrome. METHODS: This study uses data from a retrospective cohort study of reproduction and child health in which a validated postal questionnaire was sent to all UK Gulf War veterans (GWV) and a comparison cohort of Armed Service personnel who were not deployed to the Gulf (NGWV). The cohort for analysis comprises 42,818 males who responded to the questionnaire. RESULTS: We confirmed that GWV report higher rates of general ill health. GWV were significantly more likely to have reported at least one new medical symptom or disease since 1990 than NGWV (61% versus 37%, OR 2.7, 95% CI 2.5-2.8). They were also more likely to report higher numbers of symptoms. The strongest associations were for mood swings (OR 20.9, 95%CI 16.2-27.0), memory loss/lack of concentration (OR 19.6, 95% CI 15.5-24.8), night sweats (OR 9.9, 95% CI 6.5-15.2), general fatigue (OR 9.6, 95% CI 8.3-11.1) and sexual dysfunction (OR 4.6, 95%CI 3.2-6.6). 6% of GWV believed they had Gulf War syndrome (GWS), and this was associated with the highest symptom reporting. CONCLUSIONS: Increased levels of reported ill health among GWV were confirmed. This study was the first to use a questionnaire which did not focus specifically on the veterans' symptoms themselves. Nevertheless, the results are consistent with those of other studies of post-Gulf war illness and thus strengthen overall findings in this area of research. Further examination of the mechanisms underlying the reporting of ill health is required
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