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Background: Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain.
Methods: A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively.
Results: Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon’s test showed stability in responses after the 5 statements failed to reach consensus: ‘translate the STarT-Back Tool to pidgin language’ 71% (p = 0.76), ‘begin implementation with government hospitals’ 63% (p = 0.11), ‘share knowledge with traditional bone setters’ 35% (p = 0.67), ‘get second opinion on clinician’s advice’ 63% (p = 0.24) and ‘carry out online consultations’ 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: ‘patient education’ (96%), ‘quality improvement appraisals’ (96%), ‘undergraduate training on psychosocial care’ (96%) and ‘patient-clinician communication’ (95%).
Conclusion: There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.
Species distribution models (SDMs) are key tools in biodiversity and conservation, but assessing their reliability in unsampled locations is difficult, especially where there are sampling biases. We present a spatially-explicit sensitivity analysis for SDMs – SDM profiling – which assesses the leverage that unsampled locations have on the overall model by exploring the interaction between the effect on the variable response curves and the prevalence of the affected environmental conditions. The method adds a ‘pseudo-presence’ and ‘pseudo-absence’ to unsampled locations, re-running the SDM for each, and measuring the difference between the probability surfaces of the original and new SDMs. When the standardised difference values are plotted against each other (a ‘profile plot’), each point's location can be summarized by four leverage measures, calculated as the distances to each corner. We explore several applications: visualization of model certainty; identification of optimal new sampling locations and redundant existing locations; and flagging potentially erroneous occurrence records.
In this paper, the radio frequency (RF) behavior of mechanically stressed coaxial and for the first time also twisted-pair transmission lines is investigated over their service life. The main goal is to enable predictive maintenance for cables in moving applications and avoid preventive replacement. This also reduces the use of high-cost resources. For this purpose, stranded and solid-core variants of coaxial and twisted-pair type cables are mechanically loaded on the two-pulley apparatus according to EN 50396. Their RF transmission (S21) behavior is measured using a vector network analyzer and presented over bending cycles. For the first time, the phase response of mechanically loaded transmission lines is evaluated with respect to their service life. Two significant causes for the increasing attenuation and altered phase response are identified: breakage in foil screen and increasing surface roughness on the copper conductors. The identified causes are supported with literature evidence. Through measurements and theoretical calculations, it is proven that the phase is much more suitable for an assessment of the remaining service life than the amplitude. The findings can be used to implement a cable monitoring system in industrial environments which monitors the lines in-situ and reminds the user to replace them, whenever a certain wear-level is reached.
Disconnection in a left-hemispheric temporo-parietal network impairs multiplication fact retrieval
(2023)
Arithmetic fact retrieval has been suggested to recruit a left-lateralized network comprising perisylvian language areas, parietal areas such as the angular gyrus (AG), and non-neocortical structures such as the hippocampus. However, the underlying white matter connectivity of these areas has not been evaluated systematically so far. Using simple multiplication problems, we evaluated how disconnections in parietal brain areas affected arithmetic fact retrieval following stroke. We derived disconnectivity measures by jointly considering data from n = 73 patients with acute unilateral lesions in either hemisphere and a white-matter tractography atlas (HCP-842) using the Lesion Quantification Toolbox (LQT). Whole-brain voxel-based analysis indicated a left-hemispheric cluster of white matter fibers connecting the AG and superior temporal areas to be associated with a fact retrieval deficit. Subsequent analyses of direct gray-to-gray matter disconnections revealed that disconnections of additional left-hemispheric areas (e.g., between the superior temporal gyrus and parietal areas) were significantly associated with the observed fact retrieval deficit. Results imply that disconnections of parietal areas (i.e., the AG) with language-related areas (i.e., superior and middle temporal gyri) seem specifically detrimental to arithmetic fact retrieval. This suggests that arithmetic fact retrieval recruits a widespread left-hemispheric network and emphasizes the relevance of white matter connectivity for number processing.