Lumbar epidural steroids are not cost effective in sciatica

Background Lumbar Epidural Steroids Injections (ESI’s) have previously been shown to provide some degree of pain relief in sciatica. Number Needed To Treat (NNT) to achieve 50% pain relief has been estimated at 7 from the results of randomised controlled trials. Pain relief is temporary. They remain one of the most commonly provided procedures in the UK. It is unknown whether this pain relief represents good value for money. Methods 228 patients were randomised into a multi-centre Double Blind Randomised Controlled Trial. Subjects received up to 3 ESI’s or intra-spinous saline depending on response and fall off with the first injection. All other treatments were permitted. All received a review of analgesia, education and physical therapy. Quality of life was assessed using the SF36 at 6 points and compared using independent sample t-tests. Follow up was up to 1 yr. Missing data was imputed using last observation carried forward (LOCF). QALY’s (Quality of Life Years) were derived from preference based heath values (summary health utility score). SF-6D health state classification was derived from SF-36 raw score data. Standard gambles (SG) were calculated using Model 10. SG scores were calculated on trial results. LOCF was not used for this. Instead average SG were derived for a subset of patients with observations for all visits up to week 12. Incremental QALY’s were derived as the difference in the area between the SG curve for the active group and placebo group. Results SF36 domains showed a significant improvement in pain at week 3 but this was not sustained (mean 54 Active vs 61 Placebo P<0.05). Other domains did not show any significant gains compared with placebo. For derivation of SG the number in the sample in each period differed. In week 12, average SG scores for active and placebo converged. In other words, the health gain for the active group as measured by SG was achieved by the placebo group by week 12. The incremental QALY gained for a patient under the trial protocol compared with the standard care package was 0.0059350. This is equivalent to an additional 2.2 days of full health. The cost per QALY gained to the provider from a patient management strategy administering one epidural as suggested by results was £25 745.68. This result was derived assuming that the gain in QALY data calculated for patients under the trial protocol would approximate that under a patient management strategy based on the trial results (one ESI). This is above the threshold suggested by some as a cost effective treatment. Conclusions The transient benefit in pain relief afforded by ESI’s does not appear to be cost-effective. Further work is needed to develop more cost-effective conservative treatments for sciatica.

Characterization of strain in Si1-xGex films using multiple angle of incidence ellipsometry

In this letter we characterize strain in Si1-xGex based heterojunction bipolar transistors and modulation doped field effect transistors grown by rapid thermal chemical vapor deposition exploiting the phenomenon of strain-induced birefringence. The technique used is multiple angle of incidence ellipsometry at a wavelength of 670 nm to measure the ordinary and extraordinary refractive indices of the Si1-xGex films. We report measurements on thin fully strained films (with thicknesses less than the critical thickness) with Ge concentration varying from 9% to 40% with an accuracy of the order of 1 part in 10(4) and propose an empirical relation between the difference in the ordinary and extraordinary refractive indices (deltan) and the Ge concentration (x) given by deltan(x)=0.18x-0.12x(2). (C) 2000 American Institute of Physics. [S0003-6951(00)03948-6].

Low-temperature internal friction of glass ceramics

Low-temperature internal-friction measurements have been used to study the universal low-energy excitations in glasses before and after crystallization in two glass ceramics, one based on MgO-Al2O3-SiO2 (Corning Code 9606) and one based on Li2O-Al2O3-SiO2 (Corning Code 9623). In the Code 9606 sample, the number density of excitations is greatly reduced, while in the Code 9623 sample, their number density remains practically unaltered in the crystallized state. These measurements confirm the conclusions reached by Cahill et al. (preceding paper), which were based on thermal measurements up to room temperature. These measurements also demonstrate the usefulness of internal friction as a tool for the study of these low-energy excitations, since internal friction is less sensitive to defects common to glass ceramics, like magnetic impurities and grain boundaries, which tend to dominate low-temperature specific heat and thermal conductivity, respectively.

Direct versus kinetic exchange in multiband models for organic ferromagnetism

Multiband Hubbard and Pariser-Parr-Pople calculations have been carried out on mixed donor-acceptor (DA) stacks with doubly degenerate acceptor orbitals and nondegenerate donor orbitals at two-thirds filling. Model exact results for 2, 3, and 4 DA units show that McConnell's prediction of high-spin ground states in these systems is, in general, incorrect. The larger phase space available for the low-spin states leads to their kinetic stabilization in preference to high-spin states. However, for large electron-correlation strengths, the direct exchange dominates over the kinetic exchange resulting in a high-spin ground state

Novel correlations in two dimensions: Some exact solutions

We construct a new many-body Hamiltonian with two- and three-body interactions in two space dimensions and obtain its exact many-body ground state for an arbitrary number of particles. This ground state has a novel pairwise correlation. A class of exact solutions for the excited states is also found. These excited states display an energy spectrum similar to the Calogero-Sutherland model in one dimension. The model reduces to an analog of the well-known trigonometric Sutherland model when projected on to a circular ring.

Evaluación de los procesos metacognitivos en estudiantes de Grado en Maestro de Educación Infantil y Primaria en tareas de lectura

Resumen basado en el de la publicación

Motivaci??n, implicaci??n en los deberes escolares y rendimiento acad??mico

Resumen tomado de la publicaci??n

Incidence of Meares-Irlen/visual stress syndrome in reading and learning disorders : Does fluorescent lighting in classrooms affect literacy and numeracy?

Resumen tomado de la publicación

Inteligencia emocional en alumnado con necesidades de compensación educativa

Resumen tomado de la publicación

Evoluci??n de la competencia ???gesti??n de la informaci??n??? en el alumnado de Magisterio

Resumen tomado de la publicaci??n

Espacios virtuales colaborativos en la enseñanza secundaria : evaluación de la plataforma Eduagora

Resumen tomado de la publicación

Percepci??n de utilidad y grado de satisfacci??n del alumnado de formaci??n del profesorado con el M??todo del Caso

Resumen tomado de la publicaci??n

Las claves de la comunicaci??n en el teatro para beb??s

Resumen tomado de la publicaci??n