Evaluating the effectiveness of minimum chlorate technologies employed by manufacturers of skim milk powder from both microbiological quality and chemical residue perspectives.

Dairy processors in the Republic of Ireland have adopted chlorine-free chemicals for cleaning and chlorine gas for water disinfection as a means of minimizing chlorate residue in dairy products. For these 'minimum chlorate technologies' to be satisfactory, they must be able to deliver product with acceptable levels of bacteria as well as minimum levels of chlorate and other chlorine based residues. To establish the effectiveness of these technologies, sampling was conducted across the skim milk powder (SMP) manufacturing chain in 3 separate milk processing sites. Across the 3 sites a total of 11 different batches of SMP were sampled in duplicate from the whole milk silo through the manufacturing process to the powder product; yielding a total of 137 samples. Samples were tested for chlorate, perchlorate and trichloromethane alongside a suite of microbiological plate count tests including total bacteria, thermophilic bacteria, thermoduric bacteria and both mesophilic and thermophilic spore-forming bacteria. Chlorate was detected at reportable levels (≥0.01 mg/kg) in 9 of 22 SMP samples analyzed; resulting in a mean chlorate concentration 0.0183 mg/kg. Bacteria were ubiquitous across all samples analyzed with spore-forming bacteria counts ranging from 1.30 to 2.33 log cfu/ g in SMP.

A survey of enteric organisms detected by real-time PCR assay in faeces of dogs in Western Australia.

This retrospective observational study reports the enteric organisms detected in dogs in Western Australia that had a faecal PCR (fPCR) submitted to a commercial veterinary laboratory. Of 2025 fPCR results, Clostridium perfringens alpha toxin gene was most frequently detected (87.2%), followed by Campylobacter spp. (37.8%), canine parvovirus (10.5%), Giardia spp. (9.7%), Salmonella spp. (7.0%), canine enteric coronavirus (2.3%), and canine distemper virus (0.3%). C.perfringens alpha toxin gene and Campylobacter spp. were the most common organisms co-detected. There was no statistically significant seasonal variation. Further studies are required to elucidate the role these organisms play in gastrointestinal disease in dogs.

Faecal PCR panel results and clinical findings in Western Australian dogs with diarrhoea.

AIM: To describe faecal PCR (fPCR) results and clinical findings of dogs seen at a university teaching hospital for diarrhoea. DESIGN: Retrospective case series (April 2015 to July 2018). PROCEDURE: Data were collected from the hospital electronic medical records. Data extracted included signalment, history, clinical signs, treatment, fPCR panel results, other faecal diagnostic test results and antimicrobial use. RESULTS: One hundred and sixty-eight dogs with diarrhoea had a fPCR panel submitted. Most dogs (115, 68.5%) had diarrhoea of 3 days or less duration. Clostridium perfringens alpha toxin gene was most frequently detected (156, 92.9%) by fPCR, followed by Campylobacter spp. (55, 32.7%), canine parvovirus (CPV) (29, 17.3%), Salmonella spp. (14, 8.3%) and Giardia spp. (9, 5.4%). For the 45 dogs that had a negative point-of-care CPV test, 13 were CPV fPCR positive; some of which were adult dogs with current vaccination status. A total of 94/168 (56%) dogs received antimicrobials at some time during the treatment of diarrhoea. CONCLUSION: Faecal PCR panels can identify dogs with enteric organisms in their faeces that traditional faecal diagnostics may miss, thus contributing additional information to the diagnostic process. Nonetheless, fPCR results should be interpreted in light of the clinical findings, and particular consideration given to avoiding inappropriate use of antimicrobials. This study highlights that testing for C. perfringens alpha toxin gene is not likely to be diagnostically helpful, and that adult dogs with diarrhoea might be identified as CPV positive with PCR testing, despite a negative point-of-care CPV test result and a current vaccination status.

Psychometric properties of a generic health measure in Chinese patients with low back pain in Hong Kong.

In Hong Kong, the measurement of perceived health status in patients with low back pain (LBP) can be facilitated by the availability of a health profile specifically designed for the Chinese culture. This prospective observational study investigated the psychometric properties of the generic Current Perceived Health 42 (CPH42) Profile in four separate samples (totalling 473) of Chinese patients with LBP in Hong Kong. The patients completed the CPH42 Profile and the Roland LBP Disability Scale at various points in the course of physiotherapy. Their pain intensity was measured using the 11-point pain numerical rating scale (NRS). The test-retest reliability and internal consistency of the CPH42 Profile demonstrated high intra-class correlation coefficient of 0.92 and Cronbach's alpha of 0.90. Validity was confirmed by a moderate correlation with the Chinese adaptations of the Roland LBP Disability Scale and the NRS at the commencement of physiotherapy (Spearman's correlation coefficients were 0.48 and 0.42, respectively). The responsiveness, measured from the commencement of physiotherapy to weeks 3 and 6 (standard response means of 0.33 and 0.58, respectively), were commensurate with the respective changes in pain intensity. The psychometric properties of the CPH42 Profile suggest its suitability for use as an outcome instrument in future efficacy studies on LBP intervention.

Use of a subjective health measure on Chinese low back pain patients in Hong Kong.

STUDY DESIGN: A prospective observational study on the use of the Aberdeen Low Back Pain Disability Scale. OBJECTIVE: To evaluate the reliability, validity, and responsiveness of the Chinese adaptation of the Aberdeen Low Back Pain Scale in Chinese patients in Hong Kong who have back pain. SUMMARY OF BACKGROUND DATA: Frontline clinicians, researchers, and health care managers in Hong Kong are urgently in need of a Chinese adaptation of a low back pain outcome measure that has been subjected to a rigorous process of psychometric and clinical testing. METHODS: Four samples with 473 consecutive adult patients with low back pain from six physiotherapy outpatient departments in Hong Kong who completed the Aberdeen Low Back Pain Scale were observed and measured at time points including the beginning physiotherapy; 10 days, 3 weeks, and 6 weeks after physiotherapy; and when discharged from treatment. RESULTS: The test-retest reliability coefficient was 0.94 (0.94 in the original English version; figures from the English version are reported in parentheses). The Cronbach alpha coefficient was 0.85 (0.80). The Spearman correlation coefficient, when the Aberdeen score was correlated with that of a generic current 42-item questionnaire regarding the patient's perceived health to establish cross-sectional construct validity, was 0.59 (0.36-0.66, with the Short Form 36 scale). The effect sizes (responsiveness) at weeks 3 and 6 after treatment began were 0.59 and 0.81, respectively (a high of 0.62 reported in the English version). CONCLUSIONS: The Chinese version of the Aberdeen Low Back Pain Disability Scale retained the high levels of reliability, validity, and responsiveness of the original English version when tested in Hong Kong in four samples of Chinese patients with low back pain.

Dorsal root ganglion injuries in 109 blunt trauma fatalities.

In an autopsy study of 180 cervical spines, 109 were from victims of fatal blunt injury. A search was made for injuries to the dorsal root ganglia. The whole cervical spines, from the skull base to T1, were formalin fixed, deep frozen and sagittally sectioned on a specially adapted band saw in 2.5 mm thick slices. In 15 of the 109 fatally injured individuals, 44 examples of interstitial haemorrhage into a dorsal root ganglion (DRG) were found. This was sometimes accompanied by neural tissue disruption, visible only on histological study. The intraneural DRG haemorrhage was found in 13.8 per cent of all the injured individuals, but this prevalence rose to 34.5 per cent when only those (29) individuals surviving the injury between 2 h and 7 days were considered. The possible relevance of such injuries, in survivors of injury, to acute and chronic pain syndromes is discussed.

Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention.

The efficacy of specific exercise interventions that advocate training the co-contraction of the deep abdominal muscles with lumbar multifidus for treating chronic back pain conditions has not been tested. A randomized controlled trial involving 42 subjects with a specific chronic back pain condition investigated whether this form of intervention results in changes to the ratio of activation of the internal oblique relative to the rectus abdominis. Data were collected before and after the intervention, using surface electromyography, while subjects performed different abdominal maneuvers. Subjects were randomly allocated to either a specific exercise group or control group. Following intervention, the specific exercise group showed a significant (p < 0.05) increase in the ratio of activation of the internal oblique relative to the rectus abdominis. The control group showed no significant change. The study findings provide evidence that the conscious and automatic patterns of abdominal muscle activation can be altered by specific exercise interventions.

Head and shoulder posture variations in 160 asymptomatic women and men.

OBJECTIVE: To quantitatively describe the postural alignment of the head and shoulders and the surface curvature of the thoracic spine in comfortable erect standing and to examine the effect of age and gender on head and shoulder alignment. DESIGN: Descriptive survey. SETTING: Gait research laboratory. PARTICIPANTS: One hundred sixty asymptomatic volunteers aged between 17 and 83 years. MAIN OUTCOME MEASURES: Five photographic measurements of head and shoulder posture in the coronal and sagittal planes and a photographic measurement of the surface curvature of the thoracic spine in the sagittal plane. RESULTS: Mean values of coronal head tilt, coronal shoulder angle, sagittal head tilt, sagittal C7-tragus angle, and sagittal shoulder-C7 angle were 180.1 degrees, 181 degrees, 172.1 degrees, 131.1 degrees, and 53.7 degrees, respectively. The 95% confidence intervals for the means ranged between 1 degree and 3.8 degrees. For each of the head and shoulder measurements there was no significant gender difference (p = .33 to .99). Of the five measurements, only sagittal C7-tragus angle was significantly correlated with age (r = .44), and none was correlated with surface curvature of the thoracic spine. CONCLUSIONS: Head and shoulder posture was similar between genders. Only one postural description that has been described anecdotally was identified, i.e., that age was related to the position of the head with respect to the trunk in the sagittal plane, although the strength of the association was of questionable clinical significance. In contrast, other longstanding assumptions were not supported, and accordingly, a forward head was not associated with increased thoracic curvature or upper cervical spine extension.

A comparison of risk assessment of single and combination manual handling tasks: 2. Discomfort, rating of perceived exertion and heart rate measures.

Although many manual handling activities involve combinations of pull, lift, carry, lower and push, there are few reports of investigation of how to assess the risk in these combination tasks. Two strategies have been suggested in the literature for estimating the risk in a combination task based on the measures of the separate components of that task. The aim of the study was to compare the risks assessed in single manual handling tasks with those in combination tasks. Ratings of discomfort, exertion and heart rate were collected from nine male and nine female students, performing combination and single tasks. Combination tasks consisted of sequences of pull, lift, carry, lower and push tasks. Combination tasks were performed at 1.min-1 and 3.min-1 whilst single tasks (lift, lower, push, pull and carry) were performed at 3.min-1 and 6.min-1. The rating of exertion and heart rate for each combination task was compared to the exertion rating and heart rate of the single tasks which comprised the combination task using repeated measures analysis of variance with specified contrasts. Similar comparisons for the discomfort data were performed using Friedman and Wilcoxon tests. In at least one of the twelve comparisons performed for each dependent variable, the combination task value was significantly different to each single task value. The differences occurred regardless of whether the most critical single task value or an average of all single task values was used. It was concluded that the risk in combination manual tasks can not be accurately assessed by using estimates from discomfort, exertion ratings and heart rate measures of single tasks.

Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis.

STUDY DESIGN: A randomized, controlled trial, test--retest design, with a 3-, 6-, and 30-month postal questionnaire follow-up. OBJECTIVE: To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis. SUMMARY OF BACKGROUND DATA: A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine. In no study have researchers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised. METHODS: Forty-four patients with this condition were assigned randomly to two treatment groups. The first group underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects. The activation of these muscles was incorporated into previously aggravating static postures and functional tasks. The control group underwent treatment as directed by their treating practitioner. RESULTS: After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up. SUMMARY: A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.

A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar spinal block procedure.

The study was designed to test if a manipulative therapist (MT) using manual examination techniques alone or when accompanied by a verbal response from the subject as to the pain produced, could diagnose the lumbar segmental level responsible for a subjects low back pain and referred pain. The study consisted of prospective and retrospective parts where the MTs manual diagnosis of the symptomatic lumbar segmental level was compared to a segmental level diagnosis attained by subsequent or previous spinal anaesthetic blocks. In the prospective part of the study the MT's manual diagnosis was 94.12% and 52.9% sensitive in detecting the symptomatic lumbar segmental level with verbal and non-verbal subject responses, respectively. In the retrospective part of the study the MTs manual diagnosis was found to be 60.86% and 47.82% sensitive in detecting the symptomatic lumbar segmental level with verbal and non-verbal subject responses, respectively. In the prospective study the MT's manual diagnosis showed 100% and 80% specificity in detecting subjects with no history of low back pain with verbal and non-verbal subject responses, respectively, and 100% and 75% specificity in the retrospective study with verbal and non-verbal subject responses, respectively. Inter-therapist reliability analysis for the recording of passive physiological intervertebral movements (PPIVMs), passive accessory intervertebral movements (PAIVMs) and 'tissue response' showed percentage agreement rates ranging from 55% to 99%; 74% to 100% and 43% to 100%, respectively, with weighted kappa values ranging from -0.11 to 0.32; -0.15 to 0.24 and kappa values ranging from -0.16 to 0.28, respectively. This study demonstrates that a MT's manual examination when accompanied by a verbal subject response, is highly accurate in detecting the lumbar segmental level responsible for a subjects complaint.

A comparison of risk assessment of single and combination manual handling tasks: 1. maximum acceptable weight measures.

Many manual handling activities involve combinations of pull, lift, carry, lower and push, yet few studies have investigated how to assess the risk of such combination tasks. Most recommendations assume that a combination task can be split into its components for assessment. The aim of this study was to compare the risks assessed in single manual handling tasks with those in combination tasks. Nine male and nine female students participated in a study to determine Maximum Acceptable Weights (MAWs) in single and combination tasks at different frequencies (1 min-1 and 3 min-1 for combination tasks and 3 min-1 and 6 min-1 for single tasks) and heights (floor, knuckle, shoulder). Combination tasks consisted of one each of the single tasks (pull, lift, carry, lower and push). The MAW of each combination task was compared to the MAWs of the single tasks of which it was composed using repeated measures analysis of variance with specified contrasts. In at least one of the 12 comparisons each single task MAW was found to be different from its related combination task MAW. It was concluded that the current use of single task MAWs to estimate the risk in combination tasks was unacceptable. Prediction models for combination task MAWs based on single tasks MAWs were also developed, using step-wise regression. Although coefficients of determination of around 0.8 were achieved it was argued that owing to their situation-specific nature the prediction of combination task risk using single task MAWs was likely to result in unacceptable risk errors.

Extension creep in the lumbar spine.

This in vitro study was designed to examine extension creep of the lumbar spine under conditions of sustained loading. By means of a weight and pulley circuit, loads simulating lumbar extension and flexion were applied to 25 male lumbar spines removed at postmortem. Sagittal ranges of movement and the amount of creep occurring in a 20-min period at the limit of extension were recorded. The data were classified into three age group categories representing young adults, the middle-aged and the elderly. The results indicated that extension creep behaviour was similar to that of flexion creep previously reported. The elderly lumbar spines appeared to have a greater range of extension creep than those of the young and middle-aged groups, but analysis of variance showed that the difference in creep between age groups was not significant. The viscoelastic behaviour of the spinal ligaments, zygapophyseal joint capsules and intervertebral discs during extension are sufficient to produce a characteristic creep-recovery curve, but perhaps the important role that the zygapophyseal joints play in limiting extension is sufficient to prevent significant change in creep behaviour with increasing age. RELEVANCE:--This study provides information on the biomechanical responses of the lumbar spine to sustained end range extension loading. Results suggest that in the living, even brief periods of sustained extension loading may cause significant extension creep.

Exercise and spinal manipulation in the treatment of low back pain.

Current research clearly indicates the importance of exercise and mobility in the treatment of low back pain and also that bed rest and inactivity should play a relatively small part in treatment. The use of intensive, physical exercise and "work hardening" routines have been shown to be necessary for treating chronic low back pain and returning individuals to work. Evidence derived from valid clinical studies of the use of manipulation in the treatment of low back pain shows a role for it in the acute treatment of "mechanical" low back disorders. These studies have demonstrated that manipulative procedures result in more rapid pain and functional relief compared with other conservative therapies. Over a longer time frame, this advantage disappears.

Upper limb function in persons with long term paraplegia and implications for independence: Part I.

The intent of this study was to describe the effects of long term paraplegia and wheelchair use on upper limb function. Bilateral upper extremity isokinetic and grip strength, pain, and active range of motion were compared in 52 men with paraplegia (mean age 44 years; mean duration of spinal cord injury (SCI) 17 years) and 52 age and activity level matched able bodied men. The impact of upper limb pain on activities of daily living (ADL) performance was examined in the paraplegic sample. Strength was not significantly different between the two samples except for bilateral shoulder flexion (able bodied stronger) and bilateral elbow extension (paraplegia stronger). Strength changed similarly with age in the two groups. The effect of duration of SCI on strength, excluding age, was significant for grip strength only. Duration of paraplegia and activity level were better predictors of strength than age in 9 of 14 muscle groups tested, whereas in the able bodied, age was the best strength predictor. Limited bilateral shoulder internal rotation and nondominant external rotation were associated with paraplegia (shoulder p < 0.001; elbow p < 0.001; wrist/hand p < 0.001). Reported pain prevalences for the paraplegic sample were: shoulder 39%; elbow 31% and wrist/hand 40%. The paraplegic subjects' pain intensity ratings revealed them to be experiencing mild to moderate levels of upper limb pain. Shoulder pain was associated with duration of injury, exclusive of age (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Upper limb function in persons with long term paraplegia and implications for independence: Part II.

Research has shown that wheelchair use in long term paraplegia is associated with upper limb pain and degeneration that interferes with the independent performance of activities of daily living. This paper proposes a model to explain the development of upper limb problems in persons with long term paraplegia, and one that will guide in the prevention and management of this type of long term complication.

The lumbar spine: structure, function, age changes and physiotherapy.

Increasing age brings about inevitable changes in the structure, shape and function of the human lumbar spine. The primary structural age change which occurs is a selective loss of the transversely oriented trabeculae within lumbar vertebrae, which causes them to become shorter, wider and more concave at their end-plate region. This in turn leads to a progressive alteration to the shape of the lumbar discs and, together with biochemical and histological change, brings about a reduction in spinal posture, flexibility and compliance and in the ability of the lumbar region to cope with sustained loading. This information is important for physiotherapists in their treatment of lumbar spinal disorders.

Posture of the head, shoulders and thoracic spine in comfortable erect standing.

Common clinical beliefs about the relationship between postural characteristics and pain are based on mainly anecdotal evidence. This study examined the reliability of physical characteristics of the head, shoulders and thoracic spine and identified relationships among them. Measurements were made from photographs of subjects in comfortable erect standing. A forward head position was related to the curvature of the upper thoracic spine, and a forward position of the shoulders to the tilt of the head in the sagittal plane and to upper cervical extension. The magnitude of the relationships, however, was of questionable clinical significance. No relationship was found between a forward head position and forward shoulders, nor between a forward head position and upper cervical spine extension.