Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline.

Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non-invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence-based physiotherapy care to people with CF in Australia and New Zealand.

Warming influences Mg2+ content, while warming and acidification influence calcification and test strength of a sea urchin.

We examined the long-term effects of near-future changes in temperature and acidification on skeletal mineralogy, thickness, and strength in the sea urchin Tripneustes gratilla reared in all combinations of three pH (pH 8.1, 7.8, 7.6) and three temperatures (22 °C, 25 °C, 28 °C) from the early juvenile to adult, over 146 days. As the high-magnesium calcite of the echinoderm skeleton is a biomineral form highly sensitive to acidification, and influenced by temperature, we documented the MgCO3 content of the spines, test plates, and teeth. The percentage of MgCO3 varied systematically, with more Mg2+ in the test and spines. The percentage of MgCO3 in the test and teeth, but not the spines increased with temperature. Acidification did not change the percentage MgCO3. Test thickness increased with warming and decreased at pH 7.6, with no interaction between these factors. In crushing tests live urchins mostly ruptured at sutures between the plates. The force required to crush a live urchin was reduced in animals reared in low pH conditions but increased in those reared in warm conditions, a result driven by differences in urchin size. It appears that the interactive effects of warming and acidification on the Mg2+ content and protective function of the sea urchin skeleton will play out in a complex way as global climatic change unfolds.

Analgesic efficacy of high-frequency spinal cord stimulation: a randomized double-blind placebo-controlled study.

INTRODUCTION: Spinal cord stimulation is a recognized treatment of chronic neuropathic and vascular pain. Recent data suggest that the use of very high-frequency (HF) stimulation modes does produce analgesia without paresthesia. AIM OF THE STUDY: To compare the efficacy of HF stimulation (HF spinal cord stimulation [HFSCS]) and sham stimulation on the patient's global impression of change (PGIC), pain intensity, and quality of life. PATIENTS AND METHODS: Forty patients who have achieved stable pain relief with conventional SCS have been recruited. After randomization, HFSCS and sham are initiated in a double-blind randomized two-period-crossover design. RESULTS: Complete data were available from 33 patients. The primary outcome was a minimal improvement in the PGIC. The proportion of patients responding under HFSCS was 42.4% (14/33 patients) vs. 30.3% (10/33 patients) in the sham condition. The mean benefit of HF vs. sham was not statistically significant with a proportion of 11.2% in favor of HFSCS (p = 0.30). There was a highly statistically significant "period effect," irrespective of treatment received, with 51.5% of patients (N = 17) improving at visit 3 vs. 21.2% (N = 7) at visit 5 (p = 0.006). The mean pain visual analog scale (VAS) on sham was 4.26 vs. 4.35 on HFSCS (p = 0.82) and the mean EuroQol five-dimensional (EQ-5D) index with HFSCS was 0.480 vs. 0.463 with sham (p = 0.78). CONCLUSION: This is the first randomized double-blind study on SCS. HFSCS was equivalent to sham for the primary outcome (improvement of PGIC) as well as for both the secondary outcomes (VAS and EQ-5D index). There was a highly statistically significant "period effect" (p = 0.006) with improved PGIC scores in the first study period regardless of the treatment. The same trend was seen for VAS and EQ-5D. It appears that the effect of HFSCS and sham is equal and only the order in the sequence, not the nature of the treatment, seems to dictate the effect.

The phylogenetic roots of cognitive dissonance.

We presented 7 Old World monkeys (Japanese macaques [Macaca fuscata], gray-cheeked mangabey [Lophocebus albigena], rhesus macaques [Macaca mulatta], bonnet macaque [Macaca radiate], and olive baboon [Papio anubis]), 3 chimpanzees (Pan troglodytes), 6 members of the parrot (Psittacinae) family, and 4 American black bears (Ursus americanus) with a cognitive dissonance paradigm modeled after Egan, Santos, and Bloom (2007). In experimental trials, subjects were given choices between 2 equally preferred food items and then presented with the unchosen option and a novel, equally preferred food item. In control trials, subjects were presented with 1 accessible and 1 inaccessible option from another triad of equally preferred food items. They were then presented with the previously inaccessible item and a novel member of that triad. Subjects, as a whole, did not prefer the novel item in experimental or control trials. However, there was a tendency toward a subject by condition interaction. When analyzed by primate versus nonprimate categories, only primates preferred the novel item in experimental but not control trials, indicating that they resolved cognitive dissonance by devaluing the unchosen option only when an option was derogated by their own free choice. This finding suggests that this phenomenon might exist within but not outside of the primate order.