Chiropractic techniques and treatment modalities included in academic programs: A survey of chiropractic educational institutions.

OBJECTIVE: The chiropractic techniques that chiropractors learn during their training strongly influence the nature of treatments provided by chiropractors and their professional identity. The objective of this project is to provide an exhaustive description of all chiropractic techniques and treatment modalities taught in chiropractic educational institutions. METHODS: International experts were solicited to provide feedback on the exhaustivity and clarity of our preliminary questionnaire. Following the expert suggestions, we administered our cross-sectional survey representatives of all chiropractic education institutions listed on the World Federation of Chiropractic website. We also asked the contact information for an additional contact from each institution and surveyed them for triangulation purposes. RESULTS: Among the 47 chiropractic education institutions surveyed, 29 completed our survey (response rate: 62%) of which 18 (62%) had 2 respondents. Among all the chiropractic techniques and treatment modalities investigated, only the Diversified technique was included in the core curriculum of all responding institutions. A considerable proportion of the techniques or modalities studied were not included in the educational activities of the institutions, particularly within the manual tonal or reflex techniques, instrument-assisted articular techniques, as well as the other techniques or modalities categories. Surprisingly, exercise prescription was not included in the core curriculum of all the institutions. Some scientifically challenged approaches were included in the educational activities of more than 40% of the institutions. CONCLUSION: The portfolio of therapeutic teaching varies greatly between chiropractic educational institutions. A more standardized therapeutic curriculum could be beneficial to reduce public and interprofessional confusion toward therapeutic approaches in chiropractic.

Cervical artery dissections: Factors that influence causation determination in litigated cases.

In litigated cases, the suspected causes of cervical artery dissections (CADs) are a source of considerable debate among experts. In this study, we sought to examine the factors influencing court decisions and discover how Canadian tribunals analyzed and arbitrated conflicting expert opinions in CAD cases. Cases for this review were identified through searches of the Canadian CANLII database. First, the results of this study show that there is no standardized methodology to assist health care personnel in the processing and interpretation of data in individual cases of CAD. This leads to wide ranges of personal interpretations and opinions which may confuse tribunals. Of concern is the implication of treating physicians who may not have the objectivity to act as expert witnesses when one of their patients is engaged in a legal proceeding.

Lumbar disc herniation and cauda equina syndrome following spinal manipulative therapy: a review of six court decisions in Canada.

The purpose of this review is to expand practitioners' knowledge on areas of liability when treating low back pain patients. Six cases where chiropractors in Canada were sued for allegedly causing or aggravating lumbar disc herniation after spinal manipulative therapy were retrieved using the CANLII search database. The case series involves 4 men and 2 women with an average age of 37.3 years (range, 31-48 years). Trial courts' decisions were rendered between 2000 and 2011. This study highlights the following conclusions from Canadian courts: 1) informed consent is an ongoing process that cannot be entirely delegated to office personnel; 2) when the patient's history reveals risk factors for lumbar disc herniation the chiropractor has the duty to rule out disc pathology as an etiology for the symptoms presented by the patients before beginning anything but conservative palliative treatment; 3) lumbar disc herniation may be triggered by spinal manipulative therapy on vertebral segments distant from the involved herniated disc such as the thoracic spine.

Synthesis and characterization of DNA duplexes containing an N3T-ethyl-N3T interstrand crosslink in opposite orientations.

DNA duplexes containing an ethyl interstrand crosslink that bridges the N3 atoms of thymidines on the opposite strands have been synthesized using an approach that combines conventional solid phase oligonucleotide synthesis and the selective removal of protecting groups of a crosslinked thymidine dimer. This approach allows for the assembly of a crosslinked duplex directly on the solid support. Duplexes that contain a N3T-ethyl-N3T interstrand crosslink in a staggered orientation at either a -TA- or -AT-step in a duplex have been prepared. When placed in an -AT- step of a duplex the effect was stabilizing relative to the non-crosslinked control duplex (deltaTm= +24 degrees C) and this crosslinked duplex was found to efficiently form multimers in the presence of T4 ligase. In the case of the -TA- crosslinked duplex the stabilizing effect was less pronounced (deltaT.= +6 degrees C) and likewise did not undergo self ligation under identical conditions. Molecular modeling studies suggested that the -AT- containing lesion had little deviation in structure relative to the non-crosslinked duplex DNA control, whereas the -TA- crosslinked duplex exhibited significant buckling of the base pairs flanking the lesion.

Mispair-aligned N3T-alkyl-N3T interstrand cross-linked DNA: synthesis and characterization of duplexes with interstrand cross-links of variable lengths.

Therapeutic bifunctional alkylating agents generate interstrand cross-links in duplex DNA. As part of our continuing studies on DNA duplexes that contain alkyl interstrand cross-links, we have synthesized a cross-link that bridges the N(3) positions of a mismatched thymidine base pair. This cross-link, which is similar to the N(3)C-alkyl-N(3)C cross-link that has been observed between mismatched cytosine base pairs, was introduced by first incorporating a cross-linked phosphoramidite unit at the 5'-end of an oligonucleotide chain. Fully cross-linked duplexes were then synthesized using an orthogonal approach to selectively remove protecting groups, thus allowing construction of the cross-linked duplex via conventional solid-phase oligonucleotide synthesis. Short DNA duplexes with alkyl cross-links of various lengths (two, four, and seven methylene units) were prepared, and their physical properties were studied via UV thermal denaturation and circular dichroism spectroscopy. These linkers were found to stabilize the duplexes by 37, 31, and 16 degrees C for the two-, four-, and seven-carbon linkers, respectively, relative to a non-cross-linked duplex. Circular dichroism spectra suggested that these lesions induce very little deviation in the global structure relative to the non-cross-linked duplex DNA control. Molecular models show that the two-carbon cross-link spans the distance between the N(3) atoms of the T-T mismatch without perturbing the helix structure, whereas the longer linkers, particularly the seven-carbon linker, tend to push the thymines apart, creating a local distortion. This perturbation may account for the lower thermal stability of the seven-carbon versus two-carbon cross-linked duplex.