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BackgroundLow back pain (LBP) is the leading cause of years lived with disability worldwide. Most people with LBP receive the diagnosis of nonspecific LBP or sciatica. Medications are commonly prescribed but have limited analgesic effects and are associated with adverse events. A novel treatment approach is to target neurotrophins such as nerve growth factor (NGF) to reduce pain intensity. NGF inhibitors have been tested in some randomized controlled trials (RCTs) in recent years, showing promise for the treatment of chronic LBP; however, their efficacy and safety need to be evaluated to guide regulatory actions. ObjectiveThe aim of this study is to evaluate the efficacy and safety of medicines targeting neurotrophins in patients with LBP and sciatica. MethodsIn this systematic review, we will include published and unpublished records of parallel RCTs and the first phase of crossover RCTs that compare the effects of medicines targeting neurotrophins with any control group. We will search the CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, EU Clinical Trials Register, and WHO International Clinical Registry Platform databases from inception. Pairs of authors will independently screen the records for eligibility, and we will independently extract data in duplicate. We will conduct a quantitative synthesis (meta-analysis) with the studies that report sufficient data and compare the medicines of interest versus placebo. We will use random-effects models and calculate estimates of effects and heterogeneity for each outcome. We will assess the risk of bias for each study using the Cochrane Collaboration tool, and form judgments of confidence in the evidence according to GRADE recommendations. We will use the PRISMA statement to report the findings. We plan to conduct subgroup analyses by condition, type of medication, and time point. We will also assess the impact of a potential new trial on an existing meta-analysis. Data from studies that meet inclusion criteria but cannot be included in the meta-analysis will be reported narratively. ResultsThe protocol was registered on the Open Science Framework on May 19, 2020. As of December 2020, we have identified 1932 records. ConclusionsThis systematic review and meta-analysis will assess the evidence for the efficacy and safety of NGF inhibitors for pain in patients with nonspecific LBP and sciatica. The inclusion of new studies and unpublished data may improve the precision of the effect estimates and guide regulatory actions of the medications for LBP and sciatica. Trial RegistrationOpen Science Framework; https://osf.io/b8adn/ International Registered Report Identifier (IRRID)DERR1-10.2196/22905

Adaptive Comparative Judgment (ACJ), an approach to the assessment of open-ended problems which utilizes a series of comparisons to produce a standardized score, rank order, and a variety of other statistical measures, has demonstrated high levels of reliability and validity and the potential for application in a wide variety of areas. Further, research into using ACJ, both as a formative and summative assessment tool, has been conducted in multiple contexts across higher education. This systematized review of ACJ research outlines our approach to identifying, classifying, and organizing findings from research with ACJ in higher education settings as well as overarching themes and questions that remain. The intent of this work is to provide readers with an understanding of the current state of the field and several areas of potential further inquiry related to ACJ in higher education.

The Fertile Crescent, its hilly flanks and surrounding drylands has been a critical region for studying how climate has influenced societal change, and this review focuses on the region over the last 20,000 years. The complex social, economic, and environmental landscapes in the region today are not new phenomena and understanding their interactions requires a nuanced, multidisciplinary understanding of the past. This review builds on a history of collaboration between the social and natural palaeoscience disciplines. We provide a multidisciplinary, multiscalar perspective on the relevance of past climate, environmental, and archaeological research in assessing present day vulnerabilities and risks for the populations of southwest Asia. We discuss the complexity of palaeoclimatic data interpretation, particularly in relation to hydrology, and provide an overview of key time periods of palaeoclimatic interest. We discuss the critical role that vegetation plays in the human-climate-environment nexus and discuss the implications of the available palaeoclimate and archaeological data, and their interpretation, for palaeonarratives of the region, both climatically and socially. We also provide an overview of how modelling can improve our understanding of past climate impacts and associated change in risk to societies. We conclude by looking to future work, and identify themes of "scale" and "seasonality" as still requiring further focus. We suggest that by appreciating a given locale's place in the regional hydroscape, be it an archaeological site or palaeoenvironmental archive, more robust links to climate can be made where appropriate and interpretations drawn will demand the resolution of factors acting across multiple scales. This article is categorized under:Human Water > Water as Imagined and RepresentedScience of Water > Water and Environmental ChangeWater and Life > Nature of Freshwater Ecosystems.

Introduction: Patient medicines helpline services (PMHS) can reduce harm and improve medicines adherence and patient satisfaction after hospital discharge. There is little evidence of which PMHS attributes are most important to patients. This would enable PMHS providers to prioritise their limited resources to maximise patient benefit. Methods: Patient preferences for PMHS attributes were measured using a discrete choice experiment. Seven attributes were identified from past research, documentary analysis and stakeholder consultation. These were used to produce a D-efficient design with two blocks of ten choice sets incorporated into an online survey. Adults in the UK who took more than one medicine were eligible to complete the survey and were recruited via the Research for the Future database. Preferences were estimated using conditional logistic regression. Associations between participant characteristics and preferences were investigated with latent class models. Results: 460 participants completed the survey. The most valued attributes were weekend opening (willingness-to-pay, WTP: £11.20), evening opening (WTP: £8.89), and receiving an answer on the same day (WTP: £9.27). Alternative contact methods, immediate contact with a pharmacist and helpline location were valued less. Female gender and full-time work were associated with variation in preferences. For one latent class containing 27% of participants, PMHS location at the patient's hospital was the most valued attribute. Discussion: PMHS providers should prioritise extended opening hours and answering questions on the same day. Limitations include a non-representative sample in terms of ethnicity, education and geography, and the exclusion of people without internet access. [ABSTRACT FROM AUTHOR]

Background and objective Type 2 diabetes affects over half a million older Australians. Australian Medicare group exercise and education interventions can support older adults' diabetes management. However, the feasibility and acceptability of accredited exercise physiologist (AEP)-delivered services are yet to be assessed. This study aimed to assess the feasibility, acceptability and preliminary efficacy of a Medicare type 2 diabetes group exercise and education intervention for older adults. Methods This study was a single-arm feasibility, acceptability and preliminary efficacy trial of an AEP-delivered type 2 diabetes group service for older adults with the condition. Participants attended the diabetes clinic once per week for eight weeks, through Medicare, for a group exercise and education session. Attendance, participation, enjoyment, suitability, usefulness and pre--post clinical health outcomes were assessed. Results The intervention was feasible and acceptable, with 40 participants (mean [±standard deviation] age 71.8±4.5 years [range 65--81 years]; 45% female) attending 87% of sessions. Almost all participants (97%) strongly agreed that the program was enjoyable. Participants also improved fitness and cardiometabolic health outcomes. Discussion More Australians should be referred to and attend Medicare-subsidised exercise physiologist-delivered group sessions. The potential for additional sessions to achieve greater physical activity engagement and diabetes self-management should be further investigated. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTraditionally, a specific “core” exercise focus has been favoured for chronic low back pain (CLBP) which contrasts holistic exercise approaches. This study aims to explore the perceptions of exercise in people with CLBP and whether exercise itself can convey implicit messages regarding its use in CLBP management in the absence of a clinical narrative.Participants were asked about their CLBP history, views of exercise for CLBP, and current exercise behaviours through online semi-structured interviews. Then, participants watched the interviewer perform the deadlift, Jefferson curl, and bird dog and were asked if they thought each individual exercise was beneficial for CLBP, and why. Data were analysed using reflexive thematic analysis through a critical realism and social constructivism lens.All participants (n = 16) viewed all exercises as beneficial for health and pain relief, but perceived efficacy varied. “Core” exercises were deemed crucial for CLBP relief, while spinal flexion and external load were often perceived as potentially injurious. Distrust towards healthcare practitioners also influenced exercise perceptions.People with CLBP perceive different exercises to either relieve pain or improve health. Healthcare practitioners can influence these perceptions, highlighting the need for consideration of exercise perceptions in clinical contexts.Exercise itself can convey implicit messages to people with chronic low back pain irrespective of an accompanying clinical narrative.‘Core’ exercises are perceived as beneficial whereas exercises involving spinal flexion or loading may be perceived as dangerous.Exercise for reducing pain is perceived as distinctly different from gym related exercises or other exercises for improving health.Healthcare practitioners must consider their client’s exercise perceptions when using exercise as an intervention for chronic low back pain.Exercise itself can convey implicit messages to people with chronic low back pain irrespective of an accompanying clinical narrative.‘Core’ exercises are perceived as beneficial whereas exercises involving spinal flexion or loading may be perceived as dangerous.Exercise for reducing pain is perceived as distinctly different from gym related exercises or other exercises for improving health.Healthcare practitioners must consider their client’s exercise perceptions when using exercise as an intervention for chronic low back pain. [ABSTRACT FROM AUTHOR]