Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review.

BACKGROUND: The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain. METHODS: A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators. RESULTS: The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial. All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures. CONCLUSION: Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management. The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted.

Empty space and the (positive) cosmological constant.

I discuss empty space, as it appears in the physical foundations of relativistic field theories and in the semiclassical study of isolated systems. Of particular interest is the relationship between empirical measurements of the cosmological constant and the question of appropriate representation of empty space by spacetimes, or models of general relativity. Also considered is a speculative move that shows up in one corner of quantum gravity research. In pursuit of holographic quantum cosmology given a positive cosmological constant, there is evidently some freedom available for theoretical physicists to pick between two physically inequivalent spacetime representations of empty space, moving forward: de Sitter spacetime or its 'elliptic' cousin.

Local Maxima in Martensite Start Temperatures in the Transition Region between Lath and Plate Martensite in Fe-Ni Alloys.

In the binary Fe-rich Fe-Ni system, martensite start temperatures MS decrease from 500 to 200 K when Ni concentrations increase from 20 to 30 at.%. It is well known that alloys with Ni concentrations below 28.5 at.% exhibit lath martensite (LM) microstructures (athermal transformation, small crystals, accommodation by dislocations). Above this concentration, plate martensite (PM) forms (burst-like transformation, large crystals, accommodation by twins). The present work is based on a combination of (i) ingot metallurgy for the manufacturing of Fe-Ni alloys with varying Ni-concentrations, (ii) thermal analysis to measure phase transformation temperatures with a special focus on MS, and (iii) analytical orientation imaging scanning electron microscopy for a quantitative description of microstructures and crystallographic features. For Ni-concentrations close to 28.5 at.%, the descending MS-curve shows a local maximum, which has been overlooked in prior works. Beyond the local maximum, MS temperatures decrease again and follow the overall trend. The local maximum is associated with the formation of transition martensite (TM) microstructure, which exhibits LM and PM features. TM forms at higher MS temperatures, as it is accommodated by simultaneous twinning and dislocation slip. An adopted version of the Clausius-Clapeyron equation explains the correlation between simultaneous accommodation and increased transformation temperatures.

Trans-Planckian philosophy of cosmology.

I provide some philosophical groundwork for the recently proposed 'trans-Planckian censorship' conjecture in theoretical physics. In particular, I argue that structure formation in early universe cosmology is, at least as we typically understand it, autonomous with regards to quantum gravity, the high energy physics that governs the Planck regime in our universe. Trans-Planckian censorship is then seen as a means of rendering this autonomy an empirical constraint within ongoing quantum gravity research.

Priority and privilege in scientific discovery.

The priority rule in science has been interpreted as a behavior regulator for the scientific community, which benefits society by adequately structuring the distribution of intellectual labor across pre-existing research programs. Further, it has been lauded as an intuitively fair way to reward scientists for their contributions, as a special case of society's "grand reward scheme". However, we will argue that the current formal framework utilized to model the priority rule idealizes away important aspects of credit attribution, and does so in a way that impacts the conclusions drawn regarding its function in scientific communities. In particular, we consider the social dynamics of credit attribution in order to show that the priority rule can foster structural disadvantages in socially diverse science, as well as drive the distribution of intellectual labor away from optimal.

Data compilation regarding the effects of grain size and temperature on the strength of the single-phase FCC CrFeNi medium-entropy alloy.

In the present article, we present a data compilation reflecting recrystallized microstructures and the corresponding mechanical properties of an equiatomic, single-phase face-centered cubic (FCC) CrFeNi medium-entropy alloy (MEA). For the analysis, interpretation, and discussion of the data, the reader can refer to the original research article entitled "Effects of temperature on mechanical properties and deformation mechanisms of the equiatomic CrFeNi medium-entropy alloy", see Ref. (Schneider and Laplanche, Acta Mater. 204, 2020). The data related to recrystallized microstructures comprise raw backscatter electron (BSE) micrographs (tif-files) obtained using a scanning electron microscope (SEM) for six grain sizes in the range [10-160 µm], optical micrographs of the alloy with the largest grain size (d = 327 µm), pdf-reports and tables presenting the corresponding grain-size distributions (d, accounting for grain boundaries only) and crystallite-size distributions (c, which accounts for both grain and annealing twin boundaries), the annealing twin thicknesses (t), the average number of annealing twin boundaries per grain (n), and the average Taylor factor (M) of each recrystallized microstructure. These are benchmark datasets that may serve to develop new algorithms for the automated evaluation of microstructural parameters. Such algorithms would help to speed up the analyses of microstructures and improve their reliability. Furthermore, several groups pointed out that in addition to the mean grain size, other microstructural parameters such as the grain size distribution (Raeisinia et al., Model. Simul. Mater. Sc. 16, 2008) and the average number of twins per grain (Schneider et al., Int. J. Plasticity, 124, 2020) may affect some material properties (e.g. Hall-Petch strengthening). Therefore, an effort was made here to determine and report almost all the microstructural parameters describing recrystallized microstructures of FCC alloys. The mechanical-properties data are provided as excel-sheets in which the raw stress-strain curves can be found. Compression tests for alloys with different grain sizes were performed at room temperature. Additional compression tests and tensile tests for the grain size d = 160 µm were performed at temperatures between 77 K and 873 K. Characteristic mechanical properties, such as yield stresses at 0.2% plastic strain (σ0.2% ) and Hall-Petch parameters (σ0 and ky ) are given for all temperatures in the tables below. Moreover, the Hall-Petch parameters as well as the mechanical data reported in the present study could be used for data mining and implemented in programs used for alloy design.

Experimental and Theoretical Investigation on Phase Formation and Mechanical Properties in Cr-Co-Ni Alloys Processed Using a Novel Thin-Film Quenching Technique.

The Cr-Co-Ni system was studied by combining experimental and computational methods to investigate phase stability and mechanical properties. Thin-film materials libraries were prepared and quenched from high temperatures up to 700 °C using a novel quenching technique. It could be shown that a wide A1 solid solution region exists in the Cr-Co-Ni system. To validate the results obtained using thin-film materials libraries, bulk samples of selected compositions were prepared by arc melting, and the experimental data were additionally compared to results from DFT calculations. The computational results are in good agreement with the measured lattice parameters and elastic moduli. The lattice parameters increase with the addition of Co and Cr, with a more pronounced effect for the latter. The addition of ∼20 atom % Cr results in a similar hardening effect to that of the addition of ∼40 atom % Co.