BackgroundWearable long-duration low-intensity ultrasound is an emerging non-invasive and non-narcotic therapy for the daily treatment of musculoskeletal pain. The aim of this randomized, double-blind, placebo-controlled study was to examine whether long-duration low-intensity ultrasound was effective in treating pain and improving function in patients with knee osteoarthritis.MethodsNinety patients with moderate to severe knee pain and radiographically confirmed knee osteoarthritis (Kellgren-Lawrence grade I/II) were randomized for treatment with active (n = 55) or placebo (n = 35) devices applied daily to the treated knee. Investigators and subjects were blinded to treatment groups. Ultrasound (3 MHz, 0.132 W/cm2, 1.3 W) was applied with a wearable device for 4 h daily for 6 weeks, delivering 18,720 J per treatment. The primary outcome was change in pain intensity (numeric rating scale) assessed prior to intervention (baseline) and after 6 weeks. Secondary outcomes of functional change were measured at baseline and after 6 weeks using the Western Ontario McMaster Osteoarthritis Questionnaire (n = 84), along with range of motion (flexion, extension) and isometric muscle strength (flexion, extension and rotation) tests on the injured knee in a small pilot subset (n = 17).ResultsThe study had a 93% retention rate, and there were no significant differences between the groups regarding demographic variables or baseline outcome measures. Patients treated with active therapy observed a significant mean NRS pain reduction over the 6-week study of 1.96 points for active (p < 0.0001), compared with a 0.85 points reduction for placebo (p = 0.13). The functional score was also significantly improved by 505 points for the active group over the 311-point improvement for placebo group compared to baseline (p = 0.02). In the pilot subset evaluated, rotational strength increased from baseline to 6 weeks (3.2 N, p = 0.03); however, no other measures were significant.ConclusionsLong-duration low-intensity ultrasound significantly reduced pain and improved joint function in patients with moderate to severe osteoarthritis knee pain. The clinical findings suggest that ultrasound may be used as a conservative non-pharmaceutical and non-invasive treatment option for patients with knee osteoarthritis. Additional research is warranted on non-weight bearing joints of the musculoskeletal system as well as extended treatment time frames and follow-up.Trial registrationNCT02083861, registered 11 March 2014, https://clinicaltrials.gov/ct2/show/results/NCT02083861
Abstract. We discuss a method for computing p≤x 1/p, using time about x 2/3 and space about x 1/3 . It is based on the Meissel-Lehmer algorithm for computing the prime-counting function π(x), which was adapted and improved by Lagarias, Miller, and Odlyzko. We used this algorithm to determine the first point at which the prime harmonic sum first crosses 4.
There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation.
In this study, we offer a new "prompt-less" instrument for measuring students' habits of mind in the field of quantitative literacy. The instrument consists of a series of questions about a newspaper article the students read. The questions do not explicitly solicit quantitative information; students' habit of mind is assessed by their use of quantitative reasoning even when it is not asked for. Students' answers were graded according to a modified version of the Quantitative Literacy Assessment Rubric (QLAR) published in this journal (vol. 4, issue 2). We applied the instrument and rubric to assess pre-and post-intervention habits of mind in opportunistic samples of two cohorts of students: the general (non-STEM) student body and (non-STEM) honors students at Central Washington University. The intervention was a QL course designed around a collection of newspaper articles to provide authentic context. The pre-and post-course assessment showed no statistically significant improvement in either group. We close with a discussion of practical aspects of using the rubric based on our experience of using it in this QL class.
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