Back Pain Consortium (BACPAC): Protocol and Pilot Study Results for a Randomized Comparative-Effectiveness Trial of Antidepressants, Fear Avoidance Rehabilitation, or the Combination for Chronic Low Back Pain and Comorbid High Negative Affect.

OBJECTIVE: Patients with chronic low back pain (CLBP) and comorbid depression or anxiety disorders are highly prevalent. Negative affect (NA) refers to a combination of negative thoughts, emotions, and behaviors. Patients with CLBP with high NA have greater pain, worse treatment outcomes, and greater prescription opioid misuse. We present the protocol for SYNNAPTIC (SYNergizing Negative Affect & Pain Treatment In Chronic pain). DESIGN: A randomized comparative-effectiveness study of antidepressants, fear-avoidance rehabilitation, or their combination in 300 patients with CLBP with high NA. In the antidepressant- or rehabilitation-only arms, SYNNAPTIC includes an adaptive design of re-randomization after 4 months for nonresponders. SETTING: A multisite trial conducted in routine pain clinical treatment settings: pain clinics and physical and occupational therapy treatment centers. METHODS: Inclusion criteria include CLBP with elevated depression and anxiety symptoms. Antidepressant and rehabilitation treatments follow validated and effective protocols for musculoskeletal pain in patients with high NA. Power and sample size are based on superior outcomes of combination therapy with these same treatments in a 71-subject 4-arm pilot randomized controlled trial. CONCLUSIONS: SYNNAPTIC addresses the lack of evidence-based protocols for the treatment of the vulnerable subgroup of patients with CLBP and high NA. We hypothesize that combination therapy of antidepressants plus fear-avoidance rehabilitation will be more effective than each treatment alone. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04747314.

Factors that influence and change medical engagement in Australian not for profit hospitals.

PURPOSE: The study aims to assess medical engagement levels at two teaching hospitals and a 500 bed private hospital in two states operated by the same health care provider and to describe individual and organisational factors that influence and change medical engagement. DESIGN/METHODOLOGY/APPROACH: A survey was emailed to all junior and senior medical staff, seeking responses to 30 pre-determined items. The survey used a valid and reliable instrument which provided an overall index of medical engagement. Qualitative data were also collected by including an open ended question. FINDINGS: Doctors (n = 810) working at all sites are in the top 20-40 percentile when compared to Australia and the United Kingdom. Two sites in one state were in the highest relative engagement band with the other being in the high relative range when compared to the (UK) and the medium relative band when compared to sites in Australia. Senior doctors working at all three were less engaged on feeling valued and empowered, when compared to having purpose and direction or working in a collaborative culture. This appears to be related to work satisfaction and whether they feel encouraged to develop their skills and progress their careers. Junior doctors at 1 site are much less engaged than colleagues working at another. Since their formal training pathways are identical the informal training experience appears to be an engagement factor. ORIGINALITY/VALUE: Despite medical engagement being recognised as crucial, little is known about individual and organisational factors that support doctors to be engaged, particularly for juniors and in the private sector.

Analysis of Dynamic Magnetoelastic Coupling in Mechanically Driven Magnetoelectric Antennas.

Mechanically driven magnetoelectric antennas are a promising new technology that enable a reduction in antenna size by many orders of magnitude, as compared to conventional antennas. The magnetoelastic coupling in these antennas, a phenomenon playing a direct role in determining performance, has been modeled using approaches that are severely lacking in both accuracy and tractability. In response to this problem, we take a physics-based approach to the analysis of magnetoelastic coupling. We find that certain directions of applied stress will maximize the coupling and we derive general expressions to quantify it. Our results are applied in comprehensive simulations that demonstrate the dynamic nature of the coupling as well as the impact of various operating conditions and material properties. Our work contributes analytical expressions and associated insight that can serve not only as guidelines for the design of mechanically driven magnetoelectric antennas, but also as stepping stones towards the development of more accurate models.

Hydrophobic Patterning-Based 3D Microfluidic Cell Culture Assay.

Engineering physiologically relevant in vitro models of human organs remains a fundamental challenge. Despite significant strides made within the field, many promising organ-on-a-chip models fall short in recapitulating cellular interactions with neighboring cell types, surrounding extracellular matrix (ECM), and exposure to soluble cues due, in part, to the formation of artificial structures that obstruct >50% of the surface area of the ECM. Here, a 3D cell culture platform based upon hydrophobic patterning of hydrogels that is capable of precisely generating a 3D ECM within a microfluidic channel with an interaction area >95% is reported. In this study, for demonstrative purposes, type I collagen (COL1), Matrigel (MAT), COL1/MAT mixture, hyaluronic acid, and cell-laden MAT are formed in the device. Three potential applications are demonstrated, including creating a 3D endothelium model, studying the interstitial migration of cancer cells, and analyzing stem cell differentiation in a 3D environment. The hydrophobic patterned-based 3D cell culture device provides the ease-of-fabrication and flexibility necessary for broad potential applications in organ-on-a-chip platforms.