Appropriateness criteria for surgery improve clinical outcomes in patients with low back pain and/or sciatica.

STUDY DESIGN: Prospective, controlled, observational outcome study using clinical, radiographic, and patient/physician-based questionnaire data, with patient outcomes at 12 months follow-up. OBJECTIVE: To validate appropriateness criteria for low back surgery. SUMMARY OF BACKGROUND DATA: Most surgical treatment failures are attributed to poor patient selection, but no widely accepted consensus exists on detailed indications for appropriate surgery. METHODS: Appropriateness criteria for low back surgery have been developed by a multispecialty panel using the RAND appropriateness method. Based on panel criteria, a prospective study compared outcomes of patients appropriately and inappropriately treated at a single institution with 12 months follow-up assessment. Included were patients with low back pain and/or sciatica referred to the neurosurgical department. Information about symptoms, neurologic signs, the health-related quality of life (SF-36), disability status (Roland-Morris), and pain intensity (VAS) was assessed at baseline, at 6 months, and at 12 months follow-up. The appropriateness criteria were administered prospectively to each clinical situation and outside of the clinical setting, with the surgeon and patients blinded to the results of the panel decision. The patients were further stratified into 2 groups: appropriate treatment group (ATG) and inappropriate treatment group (ITG). RESULTS: Overall, 398 patients completed all forms at 12 months. Treatment was considered appropriate for 365 participants and inappropriate for 33 participants. The mean improvement in the SF-36 physical component score at 12 months was significantly higher in the ATG (mean: 12.3 points) than in the ITG (mean: 6.8 points) (P = 0.01), as well as the mean improvement in the SF-36 mental component score (ATG mean: 5.0 points; ITG mean: -0.5 points) (P = 0.02). Improvement was also significantly higher in the ATG for the mean VAS back pain (ATG mean: 2.3 points; ITG mean: 0.8 points; P = 0.02) and Roland-Morris disability score (ATG mean: 7.7 points; ITG mean: 4.2 points; P = 0.004). The ATG also had a higher improvement in mean VAS for sciatica (4.0 points) than the ITG (2.8 points), but the difference was not significant (P = 0.08). The SF-36 General Health score declined in both groups after 12 months, however, the decline was worse in the ITG (mean decline: 8.2 points) than in the ATG (mean decline: 1.2 points) (P = 0.04). Overall, in comparison to ITG patients, ATG patients had significantly higher improvement at 12 months, both statistically and clinically. CONCLUSION: In comparison to previously reported literature, our study is the first to assess the utility of appropriateness criteria for low back surgery at 1-year follow-up with multiple outcome dimensions. Our results confirm the hypothesis that application of appropriateness criteria can significantly improve patient outcomes.

Blunting the response to endotoxin in healthy subjects: effects of various doses of intravenous fish oil.

To test the dose response effect of infused fish oil (FO) rich in n-3 PUFAs on the inflammatory response to endotoxin (LPS) and on membrane incorporation of fatty acids in healthy subjects. Prospective, sequential investigation comparing three different FO doses. Three groups of male subjects aged 26.8 +/- 3.2 years (BMI 22.5 +/- 2.1). One of three FO doses (Omegaven10%) as a slow infusion before LPS: 0.5 g/kg 1 day before LPS, 0.2 g/kg 1 day before, or 0.2 g/kg 2 h before. Temperature, hemodynamic variables, indirect calorimetry and blood samples (TNF-alpha, stress hormones) were collected. After LPS temperature, ACTH and TNF-alpha concentrations increased in the three groups: the responses were significantly blunted (p < 0.0001) compared with the control group of the Pluess et al. trial. Cortisol was unchanged. Lowest plasma ACTH, TNF-alpha and temperature AUC values were observed after a single 0.2 g/kg dose of FO. EPA incorporation into platelet membranes was dose-dependent. Having previously shown that the response to LPS was reproducible, this study shows that three FO doses blunted it to various degrees. The 0.2 g/kg perfusion immediately before LPS was the most efficient in blunting the responses, suggesting LPS capture in addition to the systemic and membrane effects.

Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial.

INTRODUCTION: In recent decades the treatment of non-specific low back pain has turned to active modalities, some of which were based on cognitive-behavioural principles. Non-randomised studies clearly favour functional multidisciplinary rehabilitation over outpatient physiotherapy. However, systematic reviews and meta-analysis provide contradictory evidence regarding the effects on return to work and functional status. The aim of the present randomised study was to compare long-term functional and work status after 3-week functional multidisciplinary rehabilitation or 18 supervised outpatient physiotherapy sessions. METHODS: 109 patients with non-specific low back pain were randomised to either a 3-week functional multidisciplinary rehabilitation programme, including physical and ergonomic training, psychological pain management, back school and information, or 18 sessions of active outpatient physiotherapy over 9 weeks. Primary outcomes were functional disability (Oswestry) and work status. Secondary outcomes were lifting capacity (Spinal Function Sort and PILE test), lumbar range-of-motion (modified-modified Schöber and fingertip-to-floor tests), trunk muscle endurance (Shirado and Biering-Sörensen tests) and aerobic capacity (modified Bruce test). RESULTS: Oswestry disability index was improved to a significantly greater extent after functional multidisciplinary rehabilitation compared to outpatient physiotherapy at follow-up of 9 weeks (P = 0.012), 9 months (P = 0.023) and 12 months (P = 0.011). Work status was significantly improved after functional multidisciplinary rehabilitation only (P = 0.012), resulting in a significant difference compared to outpatient physiotherapy at 12 months' follow-up (P = 0.012). Secondary outcome results were more contrasted. CONCLUSIONS: Functional multidisciplinary rehabilitation was better than outpatient physiotherapy in improving functional and work status. From an economic point of view, these results should be backed up by a cost-effectiveness study.

Direct-on-line axial flux permanent magnet synchronous generator static and dynamic performance

In distributed energy production, permanent magnet synchronous generators (PMSG) are often connected to the grid via frequency converters, such as voltage source line converters. The price of the converter may constitute a large part of the costs of a generating set. Some of the permanent magnet synchronous generators with converters and traditional separately excited synchronous generators couldbe replaced by direct-on-line (DOL) non-controlled PMSGs. Small directly networkconnected generators are likely to have large markets in the area of distributed electric energy generation. Typical prime movers could be windmills, watermills and internal combustion engines. DOL PMSGs could also be applied in island networks, such as ships and oil platforms. Also various back-up power generating systems could be carried out with DOL PMSGs. The benefits would be a lower priceof the generating set and the robustness and easy use of the system. The performance of DOL PMSGs is analyzed. The electricity distribution companies have regulations that constrain the design of the generators being connected to the grid. The general guidelines and recommendations are applied in the analysis. By analyzing the results produced by the simulation model for the permanent magnet machine, the guidelines for efficient damper winding parameters for DOL PMSGs are presented. The simulation model is used to simulate grid connections and load transients. The damper winding parameters are calculated by the finite element method (FEM) and determined from experimental measurements. Three-dimensional finite element analysis (3D FEA) is carried out. The results from the simulation model and 3D FEA are compared with practical measurements from two prototype axial flux permanent magnet generators provided with damper windings. The dimensioning of the damper winding parameters is case specific. The damper winding should be dimensioned based on the moment of inertia of the generating set. It is shown that the damper winding has optimal values to reach synchronous operation in the shortest period of time after transient operation. With optimal dimensioning, interferenceon the grid is minimized.

Corporate Social Responsibility in the Oil and Gas Industry: Environmental Management Systems as a Source of Sustainable Development

The environmental aspect of corporate social responsibility (CSR) expressed through the process of the EMS implementation in the oil and gas companies is identified as the main subject of this research. In the theoretical part, the basic attention is paid to justification of a link between CSR and environmental management. The achievement of sustainable competitive advantage as a result of environmental capital growth and inclusion of the socially responsible activities in the corporate strategy is another issue that is of special significance here. Besides, two basic forms of environmental management systems (environmental decision support systems and environmental information management systems) are explored and their role in effective stakeholder interaction is tackled. The most crucial benefits of EMS are also analyzed to underline its importance as a source of sustainable development. Further research is based on the survey of 51 sampled oil and gas companies (both publicly owned and state owned ones) originated from different countries all over the world and providing reports on sustainability issues in the open access. To analyze their approach to sustainable development, a specifically designed evaluation matrix with 37 indicators developed in accordance with the General Reporting Initiative (GRI) guidelines for non-financial reporting was prepared. Additionally, the quality of environmental information disclosure was measured on the basis of a quality – quantity matrix. According to results of research, oil and gas companies prefer implementing reactive measures to the costly and knowledge-intensive proactive techniques for elimination of the negative environmental impacts. Besides, it was identified that the environmental performance disclosure is mostly rather limited, so that the quality of non-financial reporting can be judged as quite insufficient. In spite of the fact that most of the oil and gas companies in the sample claim the EMS to be embedded currently in their structure, they often do not provide any details for the process of their implementation. As a potential for the further development of EMS, author mentions possible integration of their different forms in a single entity, extension of existing structure on the basis of consolidation of the structural and strategic precautions as well as development of a unified certification standard instead of several ones that exist today in order to enhance control on the EMS implementation.

Spiking Back

Brock Women's Volleyball in a 1977 match.

Project Summary Back

The project summary for Alphies Trough.

Back of Thistle

This view of Thistle from the northeast is taken from what is now the Jubilee Courtyard.

Investigating the potential of thecamoebians (testate amoebae) as bio-indicators of impact of oil sands mining operations on freshwater environments in Northeastern Alberta, Canada

Thecamoebian (testate amoeba) species diversity and assemblages in reclamation wetlands and lakes in northeastern Alberta respond to chemical and physical parameters associated with oil sands extraction. Ecosystems more impacted by OSPM (oil sands process-affected material) contain sparse, low-diversity populations dominated by centropyxid taxa and Arcella vulgaris. More abundant and diverse thecamoebian populations rich in difflugiid species characterize environments with lower OSPM concentrations. These shelled protists respond quickly to environmental change, allowing year-to-year variations in OSPM impact to be recorded. Their fossil record thus provides corporations with interests in the Athabasca Oil Sands with a potential means of measuring the progression of highlyimpacted aquatic environments to more natural wetlands. Development of this metric required investigation of controls on their fossil assemblage (e.g. seasonal variability, fossilization potential) and their biogeographic distribution, not only in the constructed lakes and wetlands on the oil sands leases, but also in natural environments across Alberta.

A phenomenological approach to understanding the psychological response to chronic low back pain

Chronic low back pain (CLBP) is a complex health problem of psychological manifestations not fully understood. Using interpretive phenomenological analysis, 11 semi-structured interviews were conducted to help understand the meaning of the lived experience of CLBP; focusing on the psychological response to pain and the role of depression, catastrophizing, fear-avoidance behavior, anxiety and somatization. Participants characterized CLBP as persistent tolerable low back pain (TLBP) interrupted by periods of intolerable low back pain (ILBP). ILBP contributed to recurring bouts of helplessness, depression, frustration with the medical system and increased fear based on the perceived consequences of anticipated recurrences, all of which were mediated by the uncertainty of such pain. During times of TLBP all participants pursued a permanent pain consciousness as they felt susceptible to experience a recurrence. As CLBP progressed, participants felt they were living with a weakness, became isolated from those without CLBP and integrated pain into their self-concept.

Integrating vitrinite reflectance, rock-eval pyrolysis, flourescence microscopy and palynology of the Athabasca oil sands, Kearl Lake area, northeastern Alberta

Three cores from the Kearl Lake Oil Sands area within the Athabasca deposit of northeastern Alberta have been analyzed to understand the thermal history of the McMurray and Clearwater formations of the Lower Cretaceous Mannville Group. The approach involves the integration of vitrinite reflectance (VR), Rock-Eval pyrolysis, fluorescence microscopy, and palynology. Mean VR varies between 0.21 and 0.43% Ro and indicates thermally immature levels equivalent to the rank of lignite to sub-bituminous coal. Although differing lithologies have influenced VR to some extent (i.e., coals and bitumen-rich zones), groundwater influence and oxidation seem not to have measurably altered YR. Rock-Eval analysis points to Type III/IV kerogen, and samples rich in amorphous organic matter (ADM) show little to no fluorescence characteristics, implying a terrestrial source of origin. Palynology reveals the presence of some delicate macerals but lack of fluorescence and abundant ADM suggests some degradation and partial oxidation of the samples.

Second Welland Canal - Book 2, Survey Map 9 - Back Water Bodies in Thorold

Survey map of the Second Welland Canal created by the Welland Canal Company showing the Back Water bodies in Thorold Township. The surveyors' measurements and notes can be seen in red and black ink and pencil. A number of trees along the shores presumably used in the measurements are labelled. Local area landmarks are also identified and include streets and roads(ex. Road to Beaverdams), Shriner's Dwelling Home, a barn, and the Back Water bodies. Properties and property owners of note are: Lots 27, 28, and 29, W. Bouck, D. Shriner, and Rev. T. B. Fuller.

Second Welland Canal - Book 3, Survey Map 3 - Vanalstines Creek and Back Water in Thorold

Survey map of the Second Welland Canal created by the Welland Canal Company showing the canal in Thorold Township near Port Robinson. Identified structures associated with the Canal include towing path. The surveyors' measurements and notes can be seen in red and black ink and pencil. Local area landmarks are also identified and include roads (ex. Road to Font Hill), bridges, Back Water, and Vanalstines Creek. Properties and property owners of note are: Lots 203, 204, and 205, John Coulter, and Samuel Hill.

Second Welland Canal - Book 3, Survey Map 4 - Back Water in Thorold

Survey map of the Second Welland Canal created by the Welland Canal Company showing the Back Water from the canal in Thorold Township near Port Robinson. The surveyors' measurements and notes can be seen in red and black ink and pencil. Local area landmarks are also identified and include the Back Water from the canal. Properties and property owners of note are: Lots 205 and 206, and McAlpine.

Back to Basics: Exploring gestural habits as cues for anticipating self-injurious episodes in a child with Autism and Deafness

This research project is a longitudinal qualitative case study. It contributes to an understanding of self-injurious behaviour (SIB) by inviting the reader through the narrative of the lived experience of a fifteen year old child-informant and the network of individuals in his life. The value and importance of a case-study is that it focuses on the authenticity of the experience of living with disability. Through the use of detailed field observations, interviews and photo documents, the study thoroughly explores three main areas: quality of movements, potential cues as pre-cursors to episodes of self-injury, and purposeful communication. The research begins with a review of literature on Autism, Deafness and Self-injury, formulates the research design and orientation of Physical Education, Phenomenology and Semiotics, and then systematically explores four distinct phases in the analytical process. The aim was to explore self-injurious episodes in the child informant in hopes to translate the meaning of the behaviour and potentially utilize this to provide more opportunities for adapted physical activity. The findings reveal distinct patterns of movement cues utilized for different purposes. The implications of the findings are self-injurious episodes in the child informant are preceded by distinct patterns of movement that are potentially communicative. Suggested future direction of the research is expanding the scope to other disabilities for which verbal communication is challenging, and standardizing the translating tools to assist in understanding the communication of movement.