, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved the joint Clinical Practice Guideline (CPG) for Diagnosis and Management of Low Back Pain. This CPG was intended to provide healthcare providers a framework by which to evaluate, treat, and manage patients with low back pain (LBP). METHODS: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through September 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. A patient focus group was also convened to ensure patient values and perspectives were considered when formulating preferences and shared decision making in the guideline. RECOMMENDATIONS: The VA/DOD LBP CPG provides evidence-based recommendations for the diagnostic approach, education and self-care, non-pharmacologic and non-invasive therapy, pharmacologic therapy, dietary supplements, non-surgical invasive therapy, and team approach to treatment of low back pain.

Osteoporosis is a burgeoning clinical problem that is characterized by decreased bone strength and density. It predisposes patients to fragility fractures and debilitating spine deformities. Several complications are associated with spine surgery in patients with osteoporosis, and there is currently no treatment algorithm to guide the spine surgeon. A multidisciplinary approach to treatment of patients with osteoporosis and spine deformity or fracture is encouraged, and preoperative planning is crucial for successful surgical outcomes. Several surgical techniques have been developed to treat osteoporosis-related deformities, including posterior instrumentation with fusion. However, achieving fixation and fusion in these patients can be difficult secondary to poor bone stock. Augmentation methods to improve pedicle screw fixation have evolved, including instrumentation at multiple levels, bioactive cement augmentation, and fenestrated or expandable pedicle screws, but their impact on clinical outcomes remains unknown. Management of osteoporosis in patients undergoing spine surgery is challenging, but with appropriate patient selection, medical optimization, and surgical techniques, these patients can experience pain relief, deformity correction, and improved function.

Human tooth enamel provides a nearly permanent and chronological record of an individual's nutritional status and anthropogenic trace metal exposure during development; it might thus provide an excellent bio archive. We investigated the micro-spatial distribution of trace metals (Cu, Fe, Mg, Sr, Pb, and Zn) in 196 x 339 microm2 raster pattern areas (6.6 x 10(4) microm2) in a deciduous tooth using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS). Ablated areas include prenatal and postnatal enamel, the neonatal line, the dentine-enamel junction (DEJ), dentine, and the dentine-pulp junction. Topographic variations in the surface elemental distribution of lead, zinc, strontium, and iron intensities in a deciduous tooth revealed heterogeneous distribution within and among regions. 43Ca normalized elemental intensities showed the following order: Sr>Mg>>Zn>Pb>Fe>Cu. Elevated zinc and lead levels were present in the dental pulp region and at the neonatal line. This study demonstrates the ability of LA-ICP-MS to provide unique elemental distribution information in micro spatial areas of dental hard tissues. Elemental distribution plots could be useful in decoding nutrition and pollution information embedded in their bio apatite structure.

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There is growing consensus that exercise improves cognitive functioning, but research is needed to identify exercise interventions that optimize effects on cognition. The objective of this pilot study was to evaluate Taekwondo implemented in public middle school physical education (PE). Two classes were randomly assigned to either: five sessions per week of PE or three sessions of PE and two sessions of Taekwondo. In PE sessions, evidence-based curriculum to address the Presidential Core Fitness Guidelines and California Physical Fitness Tests was implemented. Taekwondo sessions included traditional techniques and forms taught in an environment emphasizing respect and self-control. Sixty students were evaluated at baseline and during the last week of the intervention (nine months later). Differences in mean residualized change scores for parent-rated inhibitory behavioral control yielded a significant, large effect size (d =.95, p =.00), reflecting greater improvement among Taekwondo students. Results from an executive function computer-administered task revealed greater accuracy on the congruent trial (d = 2.00, p = .02) for Taekwondo students. Differences in mean residualized change scores for BMI z scores yielded a moderate, non-significant effect size (d = − .51, p = .16). The majority of Taekwondo students reported positive perceptions of Taekwondo and perceived self-improvement in self-control and physical fitness. Results suggest that Taekwondo is an exercise program that improves cognitive functioning and is both feasible and acceptable to implement in a public school setting.