Evolving role of VIADISC for chronic low back and discogenic pain: a narrative review.

INTRODUCTION: Chronic lower back pain is a leading cause of disability and healthcare spending worldwide. Discogenic pain, pain originating from the intervertebral disk, is a common etiology of chronic lower back pain. Currently, accepted treatments for chronic discogenic pain focus only on the management of symptoms, such as pain. There are no approved treatments that stop or reverse degenerating intervertebral discs. Biologic therapies promoting disc regeneration have been developed to expand treatment options. VIADISC™ NP, is a viable disc allograft supplementation that, in a recent trial, demonstrated a significant reduction in pain and increased function in patients suffering from symptomatic degenerative disc disease. AREAS COVERED: This manuscript summarizes the epidemiology and etiology of low back pain, the pathophysiology of degenerative disc disease, current treatments, and a need for newer therapies. The rationale behind intradiscal biologics for the treatment of symptomatic degenerative disc disease is also discussed. EXPERT OPINION: Characterization of the biology leading to disc degeneration has allowed for the development of intradiscal biologics. They may soon be capable of preventing and reversing disc degeneration. Clinical trials have shown promise, but further research into efficacy and safety is needed before these therapies are widely employed.

Human Skin T Cells Express Conserved T-Cell Receptors that Cross-React with Staphylococcal Superantigens and CD1a.

Human Langerhans cells highly express CD1a antigen-presenting molecules. To understand the functions of CD1a in human skin, we used CD1a tetramers to capture T cells and determine their effector functions and TCR patterns. Skin T cells from all donors showed CD1a tetramer staining, which in three cases exceeded 10% of skin T cells. CD1a tetramer-positive T cells produced diverse cytokines, including IL-2, IL-4, IL-5, IL-9, IL-17, IL-22, and IFN-γ. Conserved TCRs often recognize nonpolymorphic antigen-presenting molecules, but no TCR motifs are known for CD1a. We detected highly conserved TCRs that used TRAV34 and TRBV28 variable genes, which is a known motif for recognition of staphylococcal enterotoxin B, a superantigen associated with atopic dermatitis. We found that these conserved TCRs did not respond to superantigen presented by CD1a, but instead showed a cross-reactive response with two targets: CD1a and staphylococcal enterotoxin B presented by classical major histocompatibility complex II. These studies identify a conserved human TCR motif for CD1a-reactive T cells. Furthermore, the demonstrated cross-reaction of T cells with two common skin-specific stimuli suggests a candidate mechanism by which CD1a and skin flora could synergize during natural immune response and in Staphylococcus-associated skin diseases.

Does small-scale irrigation provide a pathway to women's empowerment? Lessons from Northern Ghana.

Given persistent gender inequalities that influence how the benefits of technologies are distributed, the expansion of small-scale irrigation technologies requires the consideration of important gender dynamics and impacts. Women's lack of agency and access to resources relative to men, and other social constraints, often limit their ability to adopt and benefit from agricultural technologies. At the same time, expanding access to agricultural technology to women may provide a pathway for empowerment. This paper explores the potential for small-scale irrigation technologies to increase women's empowerment by evaluating the impacts of an intervention that distributed motor pumps to small groups of farmers in Northern Ghana. The paper draws on two rounds of survey data that included the Women's Empowerment in Agriculture Index, before and after the motor pump intervention was implemented. To control for possible selection bias at the baseline, the difference-in-difference method is used to estimate the impact of the program on indicators of women's empowerment. Spillover effects are estimated by comparing outcomes of farmers in treatment villages that did not receive the pumps with farmers in control villages, where no motor pumps were distributed. The results show no significant impact of the program on measures of women's empowerment. However, there are potential negative impacts, including among households that did not benefit from the intervention. The results highlight the need to pair interventions that distribute agricultural technologies with complementary investments in infrastructure that increase access to water for irrigation, as well as other activities and approaches that ensure women can reap the benefits.

Understanding the pathways to women's empowerment in Northern Ghana and the relationship with small-scale irrigation.

Women's empowerment is often an important goal of development interventions. This paper explores local perceptions of empowerment in the Upper East Region of Ghana and the pathways through which small-scale irrigation intervention targeted to men and women farmers contributes to women's empowerment. Using qualitative data collected with 144 farmers and traders through 28 individual interviews and 16 focus group discussions, this paper innovates a framework to integrate the linkages between small-scale irrigation and three dimensions of women's empowerment: resources, agency, and achievements. The relationship between the components of empowerment and small-scale irrigation are placed within a larger context of social change underlying these relationships. This shows that many women face serious constraints to participating in and benefitting from small-scale irrigation, including difficulties accessing land and water and gender norms that limit women's ability to control farm assets. Despite these constraints, many women do benefit from participating in irrigated farming activities leading to an increase in their agency and well-being achievements. For some women, these benefits are indirect-these women allocate their time to more preferred activities when the household gains access to modern irrigation technology. The result is a new approach to understanding women's empowerment in relation to irrigation technology.

Irrigation improves weight-for-height z-scores of children under five, and Women's and Household Dietary Diversity Scores in Ethiopia and Tanzania.

Evidence on the potential for agricultural intensification to improve nutrition has grown considerably. While small-scale irrigation is a key factor driving agricultural intensification in sub-Saharan Africa, its impact on nutrition has not yet been thoroughly explored. In this study, we assess the impact of adoption of small-scale irrigation in Ethiopia and Tanzania on household and women's dietary diversity, as well as children's nutrition. We use two rounds of primary data collected from irrigators and nonirrigators in Ethiopia and Tanzania. We used a panel fixed effects econometric approach to control for observed household, women and children specific characteristics as well as observed and unobserved time-invariant confounding factors. The results show that among Ethiopian households who reported having faced drought, women in irrigating households have higher Women's Dietary Diversity Score (WDDS) compared to women in nonirrigating households. In Tanzania, women in irrigating households have higher WDDS compared to nonirrigators and the impact of irrigation on WDDS more than doubles among households facing drought. In addition, among Tanzanian households who reported having faced a drought shock, irrigating households have higher Household Dietary Diversity Score compared to nonirrigators. Children in irrigating households in Ethiopia have weight-for-height z-scores (WHZ) that are 0.87 SDs higher, on average, than WHZ of children in nonirrigating households. In Tanzania, irrigation leads to higher WHZ-scores in children under-five among households who reported having experienced a drought in the 5 years preceding the survey. The study shows small-scale irrigation has a strong effect on households' economic access to food and on nutritional outcomes of women and children.

Seasonal variation in maternal dietary diversity is reduced by small-scale irrigation practices: A longitudinal study.

Some agricultural practices, such as irrigation, have the potential to buffer seasonal dietary gaps and through increased production and consumption improve diets, particularly of the rural poor relying on subsistence farming but also for rural and urban households purchasing irrigated produce on local markets. The study aimed to evaluate the effect of seasonality and irrigation on women's diet in rural Ethiopia. Using a longitudinal study design, three rounds of surveys were conducted among women of reproductive age (15-49 years). Data on socioeconomic status, food consumption and haemoglobin concentration was collected. Energy and nutrient intakes were estimated using an interviewer-administered multiple-pass 24-h recall. Women's dietary diversity score (WDDS), the proportion of women meeting the minimum dietary diversity for women (MDDW), haemoglobin concentration, the prevalence of anaemia and energy and nutrients intakes were compared between irrigators and nonirrigators and by season. Associations between MDDW/WDDS and irrigation status were assessed using fixed-effect models, after adjusting for covariates. WDDS was low (3-4 out of 10 food groups) and exhibited high seasonal variability (p < 0.05). Diets were predominantly cereal-based, with little consumption of nutrient-dense foods like fruits and animal source foods. High seasonal variability in energy, protein, vitamin C, calcium, iron and zinc intakes were observed (p < 0.01). Irrigators were more likely to meet the MDDW than women from non-irrigating households (p < 0.05). No cases of malaria were reported from the three rounds of screening. There is a high seasonal variation in women's diet, but this could be partly offset by irrigation practices.

Adapting agriculture to climate change in Kenya: household strategies and determinants.

Countries in Sub-Saharan Africa are particularly vulnerable to climate change, given dependence on agricultural production and limited adaptive capacity. Based on farm household and Participatory Rural Appraisal data collected from districts in various agroecological zones in Kenya, this paper examines farmers' perceptions of climate change, ongoing adaptation measures, and factors influencing farmers' decisions to adapt. The results show that households face considerable challenges in adapting to climate change. While many households have made small adjustments to their farming practices in response to climate change (in particular, changing planting decisions), few households are able to make more costly investments, for example in agroforestry or irrigation, although there is a desire to invest in such measures. This emphasizes the need for greater investments in rural and agricultural development to support the ability of households to make strategic, long-term decisions that affect their future well-being.

An N-heterocyclic carbene/Lewis acid strategy for the stereoselective synthesis of spirooxindole lactones.

A cooperative catalysis approach for the enantioselective formal [3+2] addition of α,ß-unsaturated aldehydes to isatins has been developed. Homoenolate annulations of ß-aryl enals catalyzed by an N-heterocyclic carbene (NHC) require the addition of lithium chloride for high levels of enantioselectivity. This NHC-catalyzed annulation has been used for the total synthesis of maremycin B.

Formal synthesis of (+)-sorangicin A.

The formal synthesis of (+)-sorangicin A was completed by two independent routes. Both approaches feature a cross metathesis reaction to form the C29-C30 bond to arrive at the bicyclic ether/tetrahydropyran fragment. Formation of the C15-C16 olefin to unite the dihydropyran fragment with the rest of the molecule was achieved by either a cross metathesis reaction or a Julia-Kocienski olefination.

Enantioselective total synthesis of spirofungins A and B.

The enantioselective total synthesis of spirofungins A (1) and B (2) is reported in 14 steps over the longest linear sequence. Key steps include the use of thiazolidinethione-mediated aldol reactions to assemble the major fragments and installation of the C1-C6 side chain using a cross metathesis reaction.

Psychological aspects of prenatal diagnosis and its implications in multiple pregnancies.

Couples expecting twins are often unrealistically optimistic and are therefore unprepared for the complications as well as the practical and emotional impact the birth of twins can have on the family. All such couples will need information and support throughout the pregnancy and beyond. In this review, the various aspects that should be addressed are discussed, in particular, health care workers and counsellors need to be aware of the stress experienced by parents who have been through prolonged treatment for infertility or who face the special problems associated with the loss of one twin (implies the loss could be other than death).

The impact of multiple preterm births on the family.

As the number of multiple births has steadily risen over the past 20 years, twins and triplets form an increasingly large proportion of the preterm population. This causes a number of stresses to their families. Addressing the cause of the epidemic of iatrogenic multiple births is the most effective way to reduce the number of preterm infants and the long-term problems to which they are prone.

The impact of multiple preterm births on the family.

Multiple births are important contributors to the preterm and low birthweight population and the numbers of twin births have been steadily rising since the early 1980s in all developed countries. This is largely due to the increased use of ovulation induction and multi-embryo transfer in the treatment of subfertility. Parents of preterm twins have been shown to be less responsive to their infants than those with singletons. Parental stress with twins has also been demonstrated by the higher incidence of maternal depression and of child abuse in multiple birth families. Furthermore, siblings of twins are more likely to have behaviour problems. Mortality and long-term morbidity rates are greatly increased amongst multiple birth children. The problems of the single surviving twin and the unaffected co-twin of a disabled child are often underestimated as is the complexity of the bereavement of parents who still have surviving multiples. Addressing the cause of the epidemic of iatrogenic multiple births is likely to be the single most effective way to reduce the number of preterm infants and the long-term problems to which they are prone.

Educating families, before, during and after a multiple birth.

Couples who are expecting twins and higher order births need specific information and support to help them prepare for the care of their babies. Professionals caring for such families should be aware of their special needs and ensure close liaison in order to provide a coordinated service throughout the pregnancy and early childhood.

Loss in higher multiple pregnancy and multifetal pregnancy reduction.

From early pregnancy into childhood, higher multiples have much higher rates of mortality, whether from spontaneous abortion, the 'vanishing twin' syndrome, fetal or infant death. Many parents must cope with the death of one baby whilst the siblings remain critically ill or later become disabled and yet there grief is often underestimated. Little is known about the long term feelings of parents who choose to have a multifetal pregnancy reduction (MFPR). Most say they made the right decision but also that there was insufficient respect for their loss. They are often anxious about what, if anything, to tell the survivors and how they might react. Long term follow-up studies of the children as well as the parents are needed. Meanwhile parents who chose to have a MFPR must be given more information and ongoing support.

Comments on and extracts from: the death of a twin: mourning and anniversary reactions - fragments of 10 years of self-analysis by George Engel.

Only recently has the special bereavement associated with the loss of a twin been generally recognised. With the notable exception of Joan Woodward, few have written on the subject. We, therefore, offer a shortened version of a paper written nearly 30 years ago. George Engel was himself a lone twin as well as being an eminent psychiatrist and psychoanalyst in the United States. The length of the paper precludes reprinting the totality but we hope readers will be encouraged to seek out the original published in The International Journal of Psycho-analysis in 1975, Vol 56 part 1, 23-40.