Segmental stabilizing exercises and low back pain: What is the evidence?

Study design: A systematic review of randomized controlled trials. Objectives: To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment. Results: Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain. Conclusion: For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions

Follow-Up Study of Emotionally Disturbed Children to Assess Community Services Available After Treatment

The purpose of this research project would be to discover, by means of a follow-up study, the kinds of community services most needed for children returning to the community from residential treatment centres for the emotionally disturbed, in their attempts to resume normal and improved levels of functioning, and to maintain this improvement, if not in fact stabilizing and bettering their adjustment still further

Periportal Capsulotomy: A Technique for Limited Violation of the Hip Capsule During Arthroscopy for Femoroacetabular Impingement.

Hip arthroscopy has become the standard treatment for symptomatic femoroacetabular impingement as patients have shown good outcomes and high satisfaction with this intervention. However, capsular management to gain access for intra-articular procedures remains greatly debated. Capsular closure is advocated particularly in the setting of interportal or T-capsulotomy to avoid complications of instability or nonhealing capsule. We introduce a technique for capsular management through a limited periportal capsulotomy during arthroscopic treatment of femoroacetabular impingement. In using dilation of the anterolateral and mid-anterior portals without completion of a full interportal capsulotomy, the stabilizing iliofemoral ligament is preserved. We have found that periportal capsulotomy provides safe and sufficient access to the hip joint without necessitating capsular closure

Penalties for Emergency Medical Treatment and Labor Act Violations Involving Obstetrical Emergencies

Introduction: The Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition – labor – specifically included in the title of the law. In light of rising maternal mortality rates in the United States, further exploration into the state of emergency obstetrical (OB) care is warranted. Understanding civil monetary penalty settlements levied by the Office of the Inspector General (OIG) related to EMTALA violations involving labor and other OB emergencies will help to inform the current state of access to and quality of OB emergency care.Methods: We reviewed descriptions of all EMTALA-related OIG civil monetary penalty settlements from 2002-2018. OB-related cases were identified using keywords in settlement descriptions. We described characteristics of settlements including the nature of the allegation and compared them with non-OB settlements.Results: Of 232 EMTALA-related OIG settlements during the study period, 39 (17%) involved active labor and other OB emergencies. Between 2002 and 2018 the proportion of settlements involving OB emergencies increased from 17% to 40%. Seven (18%) of these settlements involved a pregnant minor. Most OB cases involved failure to provide screening exam (82%) and/or stabilizing treatment (51%). Failure to arrange appropriate transfer was more common for OB  (36%) compared with non-OB settlements (21%) (p = 0.041). Fifteen (38%) involved a provider specifically directing a pregnant woman to proceed to another hospital, typically by private vehicle.Conclusion: Despite inclusion of the term “labor” in the law’s title, one in six settlements related to EMTALA violations involved OB emergencies. One in five settlements involved a pregnant minor, indicating that providers may benefit from education regarding obligations to evaluate and stabilize minors absent parental consent. Failure to arrange appropriate transfer was more common among OB settlements. Findings suggesting need for providers to understand EMTALA-specific requirements for appropriate transfer and for EDs at hospitals without dedicated OB services to implement policies for evaluation of active labor and protocols for transfer when indicated

On Influence of Intensive Stationary Electromagnetic Field on the Behavior of Fermionic Systems

Exact solutions of Schroedinger and Pauli equations for charged particles in an external stationary electromagnetic field of an arbitrary configuration are constructed. Green functions of scalar and spinor particles are calculated in this field. The corresponding equations for complex energy of particles bounded by short range potential are deduced. Boundary condition typical for delta - potential is not used in the treatment. Explicit analytical expressions are given for the shift and width of a quasistationary level for different configurations of the external field. The critical value of electric field in which the idea of quasistationary level becomes meaningless is calculated. It is shown that the common view on the stabilizing role of magnetic field concerns only scalar particles.Comment: 15 pages, no figures, LaTeX2

Closing the Transition Gap: The Rule of Law Imperative in Stabilization Environments

Using Afghanistan as a case study, examines strategic and moral aspects of establishing effective rule of law institutions to prevent and punish corruption following interventions; implications, such as for counterinsurgency efforts, and recommendations

Application of Cryogenic Treatment to Extend the Life of the TiAlN-Coated Tungsten Carbide Milling Cutter

Cutting tools are important to the manufacturing industry since they will affect production efficiency and product quality. Cryogenic treatment can improve the material properties by decreasing residual stress, stabilizing dimensional accuracy, and increasing wear resistance. The purpose of this study is to investigate the feasibility and effect of cryogenic treatment on the performance of TiAlN-coated tungsten carbide milling cutters for machining the Inconel alloy 625 in terms of different testing methods (e.g., hardness, wear resistance, residual stress, microstructure, and tool life test). Experimental results indicate that after cryogenic treatment there is less wear, the microstructure is denser, residual stress is decreased, the adhesion of coating and tungsten carbide is improved, and the tool life is effectively improved