Abstract Introduction. The biopsychosocial model has developed over the last forty years since Melzac and Wall first stated the need to broaden the biomedical view of pain mechanisms. The biopsychosocial concept is now central in contemporary understanding of human health and functioning in general, and pain in particular. An extensive biopsychosocial literature on low back pain has emerged since the paradigm shift of nearly thirty years ago, and has been reflected in evidence-based clinical practice guidelines on musculoskeletal pain. The estimation of prognosis from an episode of low back pain is particularly important to clinicians, patients, employers and third party payers. The instruments currently available however, quantify prognostic factors from a biomedical perspective, rather than the contemporary biopsychosocial model. The successful development of the biopsychosocial instrument, reported in this thesis, fills this gap in measurement, and affirms the hypothesis advanced that it is feasible to develop a valid and reliable multidimensional index to estimate prognosis from a range of biopsychosocial variables, in low back pain. The thesis describes; • A review of pain mediation/modulation • A review of the literature on the biopsychosocial model to identify a range of variables for investigation • Consideration of different outcome measures as the gold standard criterion measure • The development of the BPIP, a novel biopsychosocial instrument designed for eventual clinical use, as a means of considering non specific low back pain from a biopsychosocial perspective, and informing prognosis in patients who do not have diagnosable levels of psychopathology Methods. The Biopsychosocial Index of Prognosis (BPIP) was developed from a content map derived from the International Classification of Functioning, Health and Disease (ICF) for use in non specific low back pain of variable duration. A prototype BPIP instrument was drafted, and a peer review process resulted in item reduction. The prototype BPIP instrument was then subjected to a twenty four hour test-retest assessment of stability, prior to assessment of the prototype BPIP’s validity and internal consistency. Questionnaire packs containing the prototype BPIP instrument, a range of other measurement instruments, an informed consent form and an instruction sheet were then issued. The data were captured at baseline, six weeks, and again at twelve weeks. Recruitment of respondents was originally intended to capture a homogeneous cohort drawn from general (medical) practice. Recruitment difficulties however resulted in two distinct cohorts, a larger Australian cohort (n = 91) and a smaller New Zealand cohort (n = 27). The larger Australian group was utilised as an elucidation cohort, and the smaller New Zealand cohort was treated as a small prospective validation of the BPIP. Item reduction was undertaken and resulted in an ordinal scale for correlation with the Roland and Morris Disability Index, the criterion measure. The resulting twenty four item BPIP scale was tested for internal consistency in both the Australian and New Zealand cohorts. The baseline data from the Australian elucidation cohort were then assessed for concurrent, predictive and construct validity against the twelve week data from The Roland and Morris Disability Index (RDQ), the selected criterion measure. The New Zealand cohort was treated as a small prospective validation of the BPIP scale, with the baseline data from the BPIP correlated with the change score from the baseline to twelve weeks, of the RDQ. Analysis was undertaken using the SPSS statistical package. Results. Correlation analysis of the baseline BPIP Australian data with the twelve week RDQ Australian data resulted in reducing the prototype scale to questions which correlated at or above 0.3, a total of twenty four questions were retained. Reliability coefficients for internal consistency of the twenty four item BPIP scale were: The Australian cohort, Cronbach’s Alpha = 0.8736. The New Zealand cohort, Cronbach’s Alpha = 0.8628. A further review of the correlation analysis of the baseline BPIP Australian data with twelve week RDQ Australian data for items that correlated at or above 0.4 resulted in further item reduction of the BPIP to twelve questions. Following this further item reduction, reliability coefficients for internal consistency were: The Australian cohort, Cronbach’s Alpha = 0.875. The New Zealand cohort, Cronbach’s Alpha = 0.776. Regression analysis of the Australian cohort based on the twelve item scale demonstrated that 61.7% of the variance in the RDQ score at twelve weeks was accounted for by the BPIP scale, with p = 0.0005. Regression analysis of the change score of the RDQ with the twelve item BPIP in the New Zealand cohort demonstrated that 78.2% of the variance in RDQ scores was accounted for by the BPIP scale, with p = 0.006. Forty five point five percent of the Australian cohort improved by more than 30%, (the proposed minimal clinically important difference of the RDQ), whilst 76.9% of the New Zealand cohort improved more than thirty percent. In a post hoc analysis of the Orebro data, the longer 25 item questionnaire accounted for 97.8% of the variance in the New Zealand cohort. Conclusion. The initial hypothesis that it would be feasible to develop a valid and reliable multidimensional instrument from a range of biopsychosocial variables into a valid instrument for estimating the prognosis of an episode of low back pain is supported by the results. The utility of a biopsychosocial instrument for routine clinical use lies in the potential to predict prognosis. As low back pain is typically a recurrent problem, information on both prognosis for recovery from episodes, and the likelihood of recurrences would be helpful to both clinician and patient. For the patient, a well communicated prognosis helps assure the patient about their future, reduces uncertainty about their pain, and establishes treatment goals within the domain of informed consent. From the clinician’s perspective, a prognostic approach shifts the focus from the pain history to future outcomes and provides a context for considering how risks of future pain and dysfunction may be reduced. The BPIP scale is a biopsychosocial, prognostic instrument, which accounts for a high degree of the variance in the RDQ scores in both cohorts. Pain amelioration and functional improvement are the two key aspects of prognosis which the BPIP has been demonstrated to be both valid and reliable in predicting at the clinically important three month time point from baseline assessment. The BPIP has been demonstrated in these cohorts, to provide a reliable estimate of prognosis from a biopsychosocial perspective. The reliability of the shortened BPIP scale remained acceptable, and allowed for the scale to be contained on a single A4 page, potentially increasing the clinical utility of the instrument. When BPIP score fails to change over time, psychosocial screening and intervention may be indicated. Future work will include further validation in other subgroups and clinical environments, identification of cut points for BPIP scores, and the performance of comparative studies of the relative value of different purported prognostic indices. The BPIP is the first instrument developed to specifically to estimate prognosis from an episode of low back pain, in primary care, within the contemporary biopsychosocial model.

Thesis (Ph. D.)--Victoria University (Melbourne, Vic.), 2007. / Includes bibliographical references.

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1992. / Vita. Abstract. Includes bibliographical references (leaves 111-114). Also available via the Internet.

Zugl.: Oestrich-Winkel, Europ. Business School, Diss., 2009

Thesis (doctoral)--Göteborgs Universitet.

Thesis (doctoral)--Göteborgs Universitet.

Thesis (M.S.)--West Virginia University, 2006. / Title from document title page. Document formatted into pages; contains x, 107 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 68-71).

Valu Fa and Eastern Lau `s (two regions along Lau's back-arc spreading center) observed axial morphology suggest that Valu Fa is more magmatically robust than Eastern Lau despite Eastern Lau's spreading rate nearly doubling Valu Fa's. Early geochemical [Pearce et al., 1994] and geophysical [Martinez and Taylor, 2002] studies predict a gradational decrease in melting moving north from Valu Fa to Eastern Lau, but more recent geochemical and seismic observations ([Escrig, .et al 2009]; [Dunn and Martinez, 2011]; [Dunn et al., 2011]) show a sharper stepwise decrease in melting as the spreading center's ridge axis sweeps away from the Tofua Volcanic-Arc. As the ridge sweeps away from the volcanic-arc, the influence of the slab hydrated mantle in the melting structure of the ridge decreases. Furthermore, Eastern Lau produces a thinner crust than expected for a robust spreading center. 2-D numerical studies [Harmon and Blackmon, 2010] show a gradational decrease in melting from Valu Fa to Eastern Lau but with no corresponding thinning of Eastern Lau's crust. To understand the melting dynamics underneath Lau's back-arc spreading center and the Tofua Volcanic-Arc implementing the effects of 3-D mantle flow and slab hydration appears to be required. To explain the observed geochemical and seismic observations, three 3-D numerical were performed, using a community developed mantle convection solver (CitcomS). The first model shows that observed geometric and surface kinematic boundary conditions cause a steep gradational increase in relative melting area (anhydrous) moving northward with increasing spreading rate along the ridge axis from Valu Fa to Eastern Lau caused by a northwestern along axis mantle flow. A peak in the relative melting area appears particularly close to Eastern Lau where crust is thinnest. These predictions run in opposition to the observations. The second model shows including a viscosity reduction in the mantle wedge due to slab hydration causes a more subdued relative melting increase with spreading rate and "saddle" shaped decrease in relative melting area north of 20.9°S. This saddle shaped melting structure is caused by a reversal in along axis flow towards the southeast, which takes hot mantle from Eastern Lau and transports it underneath Valu Fa accounting for the anomalously thin crust observed at Eastern Lau. Finally, introducing a hydrated solidus increases the melt production under Valu Fau and causes a stepwise decrease in melt production at Eastern Lau due to its decreased proximity to the slab-hydrated region, consistent with the observed geochemical and seismic studies.

Numerous mathematical models have been developed to investigate the high incidence of low back pain associated with lifting activities. These mainly consider the muscle forces required to support the spine, and few have considered the additional role of curvature. One previous model which represented the spine as an arch (Aspden 1987) indicated the curvature to have a significant effect on both loading and stability of the spine. However this model included collective loading patterns for body weight and muscle forces, and only partial representation of the spine. On the basis that the level of anatomic detail of a model affects the accuracy of its predictions (McGill and Norman, 1987), this thesis describes the development of a model which provides greater detail for investigating spinal stability in the sagittal plane. The curvature of the whole spine, a distributed loading pattern for body weight, and the activity of individual spinal muscle groups have been considered. Comparison with the previous arch model has shown these to be necessary features for determining the loading and stability associated with a given posture. In particular, application of individual muscle forces provide greater control of stability at each vertebral level. By considering the force requirements of the individual muscle groups and the consequent loads at each intervertebral joint, possible areas of tissue over load can be identified.

Class of 2014 Abstract / Specific Aims: The primary aim of this project was to determine how receptive patients of Avella Specialty Pharmacy are towards using a mail-back medication disposal envelope by phone survey. This evaluated the hypothesis: participants in the Avella Pharmacy Medication Mail-Back Program will find the program helpful and easy to use. A secondary aim was to describe the participation in Avella’s pharmacy based medication mail-back program. This evaluated the hypothesis: Avella’s pharmacy based mail-back program will produce more participants versus non-participants. Methods: Patients of Avella Specialty Pharmacy with unused medications from discontinued prescriptions for any reason were offered a pre-paid Take Away™ envelope to dispose their medications. Each patient who accepted an envelope was called and asked about their experience using the envelope. Main Results: The majority of patients (58%) who were offered a medication disposal envelope agreed to receive one. All of the respondents surveyed indicated they would use their envelope to mail medications back. Patients of Avella Specialty Pharmacy think medication disposal envelopes are easy (100%) and helpful (97%) to use. Utilizing the trash or toilet to dispose of medications made up 41% of responses when asked about their usual method of medication disposal. A majority of respondents (74%) had not heard of a medication disposal program before Avella’s call regarding the envelope. Conclusion: Medication mail-back disposal envelopes are helpful and easy to use for disposing of unused medications among Avella Specialty Pharmacy patients. The majority of Avella Specialty Pharmacy patients are receptive towards receiving and using medication mail-back disposal envelopes.