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Chronic low back pain (cLBP) has been associated with changes in brain plasticity. Nonpharmacological therapies such as Manual Therapy (MT) have shown promise for relieving cLBP. However, translational neuroimaging research is needed to understand potential central mechanisms supporting MT. We investigated the effect of MT on resting-state salience network (SLN) connectivity, and whether this was associated with changes in clinical pain. Fifteen cLBP patients, and 16 matched healthy controls (HC) were scanned with resting functional Magnetic Resonance Imaging (fMRI), before and immediately after a MT intervention (cross-over design with two separate visits, pseudorandomized, grades V 'Manipulation' and III 'Mobilization' of the Maitland Joint Mobilization Grading Scale). Patients rated clinical pain (0-100) pre- and post-therapy. SLN connectivity was assessed using dual regression probabilistic independent component analysis. Both manipulation (Pre: 39.43 ± 16.5, Post: 28.43 ± 16.5) and mobilization (Pre: 38.83 ± 17.7, Post: 31.76 ± 19.4) reduced clinical back pain (P < .05). Manipulation (but not mobilization) significantly increased SLN connectivity to thalamus and primary motor cortex. Additionally, a voxelwise regression indicated that greater MT-induced increase in SLN connectivity to the lateral prefrontal cortex was associated with greater clinical back pain reduction immediately after intervention, for both manipulation (r = -0.8) and mobilization (r = -0.54). Our results suggest that MT is successful in reducing clinical low back pain by both spinal manipulation and spinal mobilization. Furthermore, this reduction post-manipulation occurs via modulation of SLN connectivity to sensorimotor, affective, and cognitive processing regions. PERSPECTIVE: MT both reduces clinical low back pain and modulates brain activity important for the processing of pain. This modulation was shown by increased functional brain connectivity between the salience network and brain regions involved in cognitive, affective, and sensorimotor processing of pain., (Copyright © 2020 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

This paper describes the modeling approach and example results for a newly introduced computational simulation tool to evaluate waste destruction in thermal incineration systems. The Configured Fireside Simulator (CFS) is a software simulator, originally developed for the Department of Defense to evaluate operations of the chemical demilitarization incinerators processing the chemical warfare agent stockpile of the US. The software was later adapted for use by the U.S. Environmental Protection Agency (EPA) to provide for the ability to run "what if" scenarios of waste streams contaminated with chemical/biological (CB) threat agents in four specific incinerators, including the EPA's pilot-scale Rotary Kiln Incinerator Simulator (RKIS) facility, as well as three commercial incinerators based on design criteria for actual operating facilities. These commercial incinerators include a Medical/Pathological Waste Incinerator, a Hazardous Waste Burning Rotary Kiln, and a Waste-to-Energy Stoker-type combustor. The CFS uses three-dimensional computational fluid dynamics coupled with detailed chemical kinetic data for destruction of chemical warfare agents, coupled with kinetic data for biological agent destruction derived from bench- and pilot-scale experiments to predict the way agent-containing materials will behave under full-scale combustion conditions in several different incinerator types. The objective of this paper is to describe the CFS software, how it works, and potential applications of this software to real-world situations. This software could be a valuable tool for researchers, regulators, and industry to evaluate potential operating conditions to help guide testing activities and develop operational scenarios for difficult-to-manage waste streams. Although this software has been under development for several years, this paper represents the software's first introduction to the scientific community in the peer-reviewed literature. Implications: Adapting the Configured Fireside Simulator that was originally developed for the Department of Defense to evaluate operations of the chemical demilitarization incinerators processing the chemical warfare agent stockpile of the US to provide for the ability to run "what if" scenarios on civilian waste streams contaminated with CB agents is a useful tool for national preparedness. Such a model could be used in planning and response efforts to provide a better understanding of incineration capacity, development of feed strategies, and assessment of throughput limitations for CB incidents as well as other difficult-to-test waste streams and contaminants.

Heightened anticipation and fear of movement-related pain has been linked to detrimental fear-avoidance behavior in chronic low back pain (cLBP). Spinal manipulative therapy (SMT) has been proposed to work partly by exposing patients to nonharmful but forceful mobilization of the painful joint, thereby disrupting the relationship among pain anticipation, fear, and movement. Here, we investigated the brain processes underpinning pain anticipation and fear of movement in cLBP, and their modulation by SMT, using functional magnetic resonance imaging. Fifteen cLBP patients and 16 healthy control (HC) subjects were scanned while observing and rating video clips depicting back-straining or neutral physical exercises, which they knew they would have to perform at the end of the visit. This task was repeated after a single session of spinal manipulation (cLBP and HC group) or mobilization (cLBP group only), in separate visits. Compared with HC subjects, cLBP patients reported higher expected pain and fear of performing the observed exercises. These ratings, along with clinical pain, were reduced by SMT. Moreover, cLBP, relative to HC subjects, demonstrated higher blood oxygen level-dependent signal in brain circuitry that has previously been implicated in salience, social cognition, and mentalizing, while observing back straining compared with neutral exercises. The engagement of this circuitry was reduced after SMT, and especially the spinal manipulation session, proportionally to the magnitude of SMT-induced reduction in anticipated pain and fear. This study sheds light on the brain processing of anticipated pain and fear of back-straining movement in cLBP, and suggests that SMT may reduce cognitive and affective-motivational aspects of fear-avoidance behavior, along with corresponding brain processes. PERSPECTIVE: This study of cLBP patients investigated how SMT affects clinical pain, expected pain, and fear of physical exercises. The results indicate that one of the mechanisms of SMT may be to reduce pain expectancy, fear of movement, and associated brain responses., (Copyright © 2018 the American Pain Society. Published by Elsevier Inc. All rights reserved.)