Is surgery more effective than non-surgical treatment for spinal stenosis and which non-surgical treatment is more effective? a systematic review

BACKGROUND: Spinal stenosis can be treated both conservatively and with decompression surgery. OBJECTIVES: To explore the effectiveness of surgery vs conservative treatment, and conservative interventions for spinal stenosis. DATA SOURCES: Medline, CINAHL, AMED, PEDro and Cochrane databases, as well as the reference lists of retrieved studies. STUDY SELECTION: The search included non-English studies, and all conservative interventions were included. STUDY APPRAISAL: The PEDro scale was used to assess quality, and levels of evidence were used to synthesise studies where possible. RESULTS: Thirty-one studies met the inclusion criteria, and 18 were high-quality studies. Decompression surgery was more effective than conservative care in four out of five studies, but only one of these was of high quality. In six high-quality studies, there was strong evidence that steroid epidural injections were not effective; in four out of five studies (two of which were of high quality), there was moderate evidence that calcitonin was not effective. There was no evidence for the effectiveness of all other conservative interventions. LIMITATIONS: Further research is needed to determine if decompression surgery is more effective than conservative care, and which conservative care is most effective. CONCLUSION AND IMPLICATIONS: At present, there is no evidence that favours the effect of any conservative management for spinal stenosis. There is an urgent need to see if any conservative treatment can change pain and functional outcomes in spinal stenosis.</p

OSDF: A Framework For Software Defined Network Programming

Using SDN to configure and control a multi-site network involves writing code that handles low-level details. We describe preliminary work on a framework that takes a network description and set of policies as input, and handles all the details of deriving routes and installing flow rules in switches. The paper describes key software components and reports preliminary results.Comment: 4 pages, 4 figures, accepted as a work in progress paper in CCNC 201

The nonlinear development of the relativistic two-stream instability

The two-stream instability has been mooted as an explanation for a range of astrophysical applications from GRBs and pulsar glitches to cosmology. Using the first nonlinear numerical simulations of relativistic multi-species hydrodynamics we show that the onset and initial growth of the instability is very well described by linear perturbation theory. In the later stages the linear and nonlinear description match only qualitatively, and the instability does not saturate even in the nonlinear case by purely ideal hydrodynamic effects.Comment: 15 pages, 9 figure

An agent-based simulation of the emergence of partnership systems in early renaissance florence

The emergence of the partnership system in Early Renaissance Florence is often noted as a pivotal moment in the formation of capitalism. However, this social invention was not developed as a completely redefined system, but was the gradual process of adapting guild partnerships to domestic and international business. The purpose for this paper is to describe a simplistic agent-based model, where individuals form partnerships based on paradigms common in the medieval Florentine economy, as well as the results of the simulations. The final result is the emergence of entirely different partnership network structures, consistent with the structures seen in the early 15th century, as well as a rise in individual capital which led to the success of this system replicating itself across the European landscape