A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy

Aim: To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy.

Background: International research demonstrates that 25-30% of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness.

Design: A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy.

Data Sources: Cochrane library (1898-2013), PubMed (1996-2013), MEDLINE (1946-2013), AMED (1985-2013), Embase (1974-2013), Cinahl (1937-2013), Index to Thesis (1716-2013) and Ethos (1914-2013).

Review Methods: Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool.

Results: Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However, osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.

Conclusion: There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.

Understanding controls on cirque floor altitudes: insights from Kamchatka

Glacial cirques reflect former regions of glacier initiation, and are therefore used as indicators of past climate. One specific way in which palaeoclimatic information is obtained from cirques is by analysing their elevations, on the assumption that cirque floor altitudes are a proxy for climatically controlled equilibrium-line altitudes (ELAs) during former periods of small scale (cirque-type) glaciation. However, specific controls on cirque altitudes are rarely assessed, and the validity of using cirque floor altitudes as a source of palaeoclimatic information remains open to question. In order to address this, here we analyse the distribution of 3520 ice-free cirques on the Kamchatka Peninsula (eastern Russia), and assess various controls on their floor altitudes. In addition, we analyse controls on the mid-altitudes of 503 modern glaciers, currently identifiable on the peninsula, and make comparisons with the cirque altitude data. The main study findings are that cirque floor altitudes increase steeply inland from the Pacific, suggesting that moisture availability (i.e., proximity to the coastline) played a key role in regulating the altitudes at which former (cirque-forming) glaciers were able to initiate. Other factors, such as latitude, aspect, topography, geology and neo-tectonics seem to have played a limited (but not insignificant) role in regulating cirque floor altitudes, though south-facing cirques are typically higher than their north-facing equivalents, potentially reflecting the impact of prevailing wind directions (from the SSE) and/or variations in solar radiation on the altitudes at which former glaciers were able to initiate. Trends in glacier and cirque altitudes across the peninsula are typically comparable (i.e., values typically rise from both the north and south, inland from the Pacific coastline, and where glaciers/cirques are south-facing), yet the relationship with latitude is stronger for modern glaciers, and the relationship with distance to the coastline (and to a lesser degree with aspect) is notably weaker. These differences suggest that former glacier initiation (leading to cirque formation) was largely regulated by moisture availability (during winter months) and the control this exerted on accumulation; whilst the survival of modern glaciers is also strongly regulated by the variety of climatic and non climatic factors that control ablation. As a result, relationships between modern glacier mid-altitudes and peninsula-wide climatic trends are more difficult to identify than when cirque floor altitudes are considered (i.e., cirque-forming glaciers were likely in climatic equilibrium, whereas modern glaciers may not be).

Strange, But True? Object-oriented Programming Is Best Taught, And Learnt, While Sitting On The Floor.

There is a perception amongst some of those learning computer programming that the principles of object-oriented programming (where behaviour is often encapsulated across multiple class files) can be difficult to grasp, especially when taught through a traditional, didactic ‘talk-and-chalk’ method or in a lecture-based environment.
We propose a non-traditional teaching method, developed for a government funded teaching training project delivered by Queen’s University, we call it bigCode. In this scenario, learners are provided with many printed, poster-sized fragments of code (in this case either Java or C#). The learners sit on the floor in groups and assemble these fragments into the many classes which make-up an object-oriented program.
Early trials indicate that bigCode is an effective method for teaching object-orientation. The requirement to physically organise the code fragments imitates closely the thought processes of a good software developer when developing object-oriented code.
Furthermore, in addition to teaching the principles involved in object-orientation, bigCode is also an extremely useful technique for teaching learners the organisation and structure of individual classes in Java or C# (as well as the organisation of procedural code). The mechanics of organising fragments of code into complete, correct computer programs give the users first-hand practice of this important skill, and as a result they subsequently find it much easier to develop well-structured code on a computer.
Yet, open questions remain. Is bigCode successful only because we have unknowingly predominantly targeted kinesthetic learners? Is bigCode also an effective teaching approach for other forms of learners, such as visual learners? How scalable is bigCode: in its current form can it be used with large class sizes, or outside the classroom?

Basalt Fibre Reinforced Polymer Strengthening of Normal Strength Reinforced Concrete Floor Slabs Subject to Arching Effects

With ever increasing demands to strengthen existing reinforced concrete structures to facilitate higher loading due to change of use and to extend service lifetime, the use of fibre reinforced polymers (FRPs) in structural retrofitting offers an opportunity to achieve these aims. To date, most research in this area has focussed on the use of glass fibre reinforced polymer (GFRP) and carbon fibre reinforced polymer (CFRP), with relatively little on the use of basalt fibre reinforced polymer (BFRP) as a suitable strengthening material. In addition, most previous research has been carried out using simply supported elements, which have not considered the beneficial influence of in-plane lateral restraint, as experienced within a framed building structure. Furthermore, by installing FRPs using the near surface mounted (NSM) technique, disturbance to the existing structure can be minimised.
This paper outlines BFRP NSM strengthening of one third scale laterally restrained floor slabs which reflect the inherent insitu compressive membrane action (CMA) in such slabs. The span-to-depth ratios of the test slabs were 20 and 15 and all were constructed with normal strength concrete (~40N/mm2) and 0.15% steel reinforcement. 0.10% BFRP was used in the retrofitted samples, which were compared with unretrofitted control samples. In addition, the bond strength of BFRP bars bonded into concrete was investigated over a range of bond lengths with two different adhesive thicknesses. This involved using an articulated beam arrangement in order to establish optimum bond characteristics for use in strengthening slab samples.