Spine radiography in the evaluation of back and neck pain in an orthopaedic emergency clinic

BACKGROUND AND OBJECTIVES Despite the recommendations of national and international societies for the treatment of patients with acute neck and back pain, still too many radiologic examinations were performed. The purpose of this study was to analyze and optimize diagnostics and treatment of patients with acute back pain. METHODS The medical records of 484 patients presented to the emergency clinic with acute neck or back pain were analyzed for clinical history, physical examination, radiographic findings and therapy. RESULTS Radiographs of the lumbar, cervical, or thoracic spine were performed in 338 cases (70%). Radiographs were normal in 142 patients (42%) and degenerative changes were identified in 123 patients (36%). Only 2 patients (0.4%) had radiographic findings that had direct therapeutic relevance: 1 patient with metastatic disease and 1 patient with posttraumatic C1-C2 instability. For most patients without sensorimotor deficits and absent specific indications for radiography (“red flags”), therapy was not affected by the results of radiography. CONCLUSIONS Plain radiography of the spine was unnecessary in most patients initially evaluated with non-specific acute back pain and does not improve the clinical outcome. The implementation of national and international guidelines is a slow process, but helps to reduce costs and to protect patients from unnecessary ionizing radiation exposure.

BRONCHOALVEOLAR LAVAGE AND GALLIUM-67 LUNG SCANNING IN THE EVALUATION OF ASBESTOS-EXPOSED INDIVIDUALS

In this study, an attempt is made to evaluate certain parameters that might indicate the beginning of a certain fibrogenic activity in the lung parenchyma, even before such changes become visible on the chest x-ray. The hypothesis is that studies such as certain bronchoalveolar immunological characteristics and Gallium-67 lung scans may be more sensitive indicators of parenchymal lung damage in response to asbestos inhalation than conventional radiographic criteria. If so, then in those cases where the criteria for the diagnosis of asbestosis lack the presence of parenchymal changes, it would be unwise to deny the diagnosis unless further investigations, such as the bronchoalveolar lavage fluid analysis and the Gallium-67 lung scan techniques, are made available.^ Four groups of individuals have been included in this study. The volunteer group showing no history of asbestos exposure with normal chest x-rays has been used as a normal healthy comparison group. The other three groups are all asbestos-exposed but differ as to their findings in the chest radiographs. One has parenchymal changes (0/1 or more, ILO Classification), the second has no parenchymal but pleural changes, and the third has neither.^ The most significant laboratory parameter for bronchoalveolar lavage, in this study, is that of Neutrophils (PMNs). All three asbestos-exposed groups showed no differences when compared with each other, while such differences were statistically significant when such groups were separately compared with the normal comparison group. A similar finding existed also when the Helper: Suppressor T-Cell ratios were compared, and found to be higher in all the asbestos-exposed groups.^ Another sensitive test is that of Gallium-67 lung scan. This was found to be positive in some patients where parenchymal changes were absent. Even in some of those who showed neither parenchymal nor pleural changes in their chest x-ray showed positive test results. Such changes indicate a state of an underlying pathogenic process that is still undetectable by conventional radiography. This highly recommends the future application of such tests for the early detection of active pulmonary disease, especially in those who show no parenchymal changes in their chest x-rays. (Abstract shortened with permission of author.) ^

The Bangladesh gender gap in education : biased intra-household educational expenditures

By investigating the educational expenditure of children over the ten years (2000 to 2010), we evaluate whether there exists any gender specific discrepancy at the household level and the trend of such discrepancy over the years. Using three rounds of nationally representative Household Income & Expenditure Surveys this study reveals that households spend less on education for their school-going girls compared to boys. By disaggregating the total expenditure into fixed and variable components, we find persistent gender imbalance in educational expenditure where households provide better quality of education for boys. Moreover, we find that gender based discrepancy has a very persistent trend and does not show any significant sign of narrowing the gap over the years. Cohort wise difference-in-difference estimation also reveals that the gap has initially widened and later converged but has not diminished beyond the initial level of discrepancy, which may warrant targeted policy intervention.

UBURYO: open source software for managing microcredits in education

One of the major problems in developing countries is minority access to higher education. Traditional scholarships usually focus on paying tuition fees for bringing brilliant students to developed countries (from where they seldom return). But local grants seldom target the more needy students. We propose a system of student loans to pay tuition fees in exchange for technical work. This appears to be a satisfactory and sustainable solution. We also provide UBURYO (a Kirundi word meaning opportunity). UBURYO is the free open source software, that we have developed, to manage this loan system in a simple, trustworthy, fair and efficient way.

In vitro evaluation of commercial fibrolytic enzymes for improving the nutritive value of low-quality forages.

The aim of this work was to assess the effects of four doses of three commercial fibrolytic enzymes on ruminal fermentation of rice straw, maize stover and Pennisetum purpureum clon Cuba CT115 hay in batch cultures of ruminal micro-organisms from sheep. One enzyme was produced by Penicillium funiculosum (PEN) and two were from Trichoderma longibrachiatum (TL1 and TL2). Each liquid enzyme was diluted 200 (D1), 100 (D2), 50 (D3) and 10 (D4) - fold and applied to each substrate in quadruplicate over time and incubated for 120 h in rumen fluid. The D4 dose of each enzyme increased (P<0.05) the fractional rate of gas production and organic matter effective degradability for all substrates, and TL2 had similar effects when applied at D3. In 9 h incubations, PEN at D4, TL1 at all tested doses, and TL2 at D2, D3 and D4 increased (P<0.05) volatile fatty acid production and dry matter degradability for all substrates. The commercial enzymes tested were effective at increasing in vitro ruminal fermentation of low-quality forages, although effective doses varied with the enzyme.

Multiple proportion case-basing driven CBRE and its application in the evaluation of possible failure of firms

Case-based reasoning (CBR) is a unique tool for the evaluation of possible failure of firms (EOPFOF) for its eases of interpretation and implementation. Ensemble computing, a variation of group decision in society, provides a potential means of improving predictive performance of CBR-based EOPFOF. This research aims to integrate bagging and proportion case-basing with CBR to generate a method of proportion bagging CBR for EOPFOF. Diverse multiple case bases are first produced by multiple case-basing, in which a volume parameter is introduced to control the size of each case base. Then, the classic case retrieval algorithm is implemented to generate diverse member CBR predictors. Majority voting, the most frequently used mechanism in ensemble computing, is finally used to aggregate outputs of member CBR predictors in order to produce final prediction of the CBR ensemble. In an empirical experiment, we statistically validated the results of the CBR ensemble from multiple case bases by comparing them with those of multivariate discriminant analysis, logistic regression, classic CBR, the best member CBR predictor and bagging CBR ensemble. The results from Chinese EOPFOF prior to 3 years indicate that the new CBR ensemble, which significantly improved CBRs predictive ability, outperformed all the comparative methods.

Out of hours service in Denmark: evaluation five years after reform

Objective: Five years after its introduction, to evaluate the 1992 reform in the out of hours service in Denmark.

Attitudes towards disability in education through the SSCI (2000-2011): a topical and bibliometric analysis

Introduction. The purpose of this study is to describe and characterize the international sci-entific output relating to “attitudes towards disability in education”, using a battery of bibliometric indicators that make it possible to analyze and monitor international scientific activity. Method. This ex post facto retrospective study analyzed 925 papers published in the Social Sciences Citation Index (SSCI) database during the period 2000-2011. Results. The number of publications increased steadily between 2006 and 2010. The results reported here include the most productive authors, the journals that deal with this topic, and the articles cited most often. An analysis of research types showed a tendency toward empiri-cal studies. A total of 18 categories were identified when considering article content, and the distribution of the research studies across stages of education was found to be uneven. Discussion and Conclusion. The results reveal a topic that is highly current in today’s scien-tific community, and offer us a view of the traits that have characterized research on "attitudes towards disability in education" for the last eleven years.

Pitfalls in the Evaluation of the Thermodynamic Consistency of Experimental VLE Data Sets

The thermodynamic consistency of almost 90 VLE data series, including isothermal and isobaric conditions for systems of both total and partial miscibility in the liquid phase, has been examined by means of the area and point-to-point tests. In addition, the Gibbs energy of mixing function calculated from these experimental data has been inspected, with some rather surprising results: certain data sets exhibiting high dispersion or leading to Gibbs energy of mixing curves inconsistent with the total or partial miscibility of the liquid phase, surprisingly, pass the tests. Several possible inconsistencies in the tests themselves or in their application are discussed. Related to this is a very interesting and ambitious initiative that arose within the NIST organization: the development of an algorithm to assess the quality of experimental VLE data. The present paper questions the applicability of two of the five tests that are combined in the algorithm. It further shows that the deviation of the experimental VLE data from the correlation obtained by a given model, the basis of some point-to-point tests, should not be used to evaluate the quality of these data.