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

Safety and Its Ethical Challenges for the Christian Engineer in a Technological Society

In every major corporation safety is a high priority and corporate policy statements stress the company’s commitment to keep people and the environment safe. However, safety comes at a cost. Corporations are in business to make profits by providing quality products and services for consumers at affordable prices. Engineers play a critical role in the design, construction, and operation of corporations across the globe and are constantly challenged to find new ways of doing things in order to reduce operating expenses in a competitive global economy. Companies must keep pace with the latest technological innovation or face the prospects of going out of business. Constant economic pressures put engineers in positions to make tough decisions about where to cut costs. When safety is compromised for economic reasons or any other reason, people and the environment are at risk. For the Christian engineer, these ethical decisions may be different and rise to a higher standard than that required by a corporation’s code of ethics[1]. A Christian engineer motivated by faith in God and acting on biblical principles will often reach different conclusions from those operating strictly from a corporate business model based on maximizing profits. Philosophical ethical systems fall short of the Biblical ideal[2]. In facing ethical challenges related to safety, the Christian engineer should propose strategies and standards that follow from the command, “Love your neighbor as yourself.” [1] Martin, M., & Schinzinger, R. (1996). Ethics in Engineering. New York: McGraw-Hill. [2] Holmes, A. F. (2007). Ethics: Approaching Moral Decisions. Downers Grove, IL: InterVarsity Press

DYNAMIC RELAXATION PROPERTIES OF AROMATIC POLYIMIDES AND POLYMER NANOCOMPOSITES

The dynamic relaxation characteristics of Matrimid® (BTDA-DAPI) polyimide and several functionalized aromatic polyimides have been investigated using dynamic mechanical and dielectric methods. The functionalized polyimides were thermally rearranged to generate polybenzoxazole membranes with controlled free volume characteristics. All polyimides have application in membrane separations and exhibit three motional processes with increasing temperature: two sub-glass relaxations (ƴ and β transitions), and the glass-rubber (α) transition. For Matrimid, the low-temperature ƴ transition is purely non-cooperative, while the β sub-glass transition shows a more cooperative character as assessed via the Starkweather method. For the thermally rearranged polyimides, the ƴ transition is a function of the polymer synthesis method, thermal history, and ambient moisture. The β relaxation shows a dual character with increasing thermal rearrangement, the emerging lower-temperature component reflecting motions encompassing a more compact backbone contour. For the glass-rubber (α) transition, dynamic mechanical studies reveal a strong shift in Tα to higher temperatures and a progressive reduction in relaxation intensity with increasing degree of thermal rearrangement. The dynamic relaxation characteristics of poly(ether imide) and poly(methyl methacrylate) nanocomposites were investigated by dynamic mechanical analysis and dielectric spectroscopy. The nanoparticles used were native and surface-modified fumed silicas. The nanocomposites display a dual glass transition behavior encompassing a bulk polymer glass transition, and a second, higher-temperature transition reflecting relaxation of polymer chain segments constrained owing to their proximity to the particle surface. The position and intensity of the higher-temperature transition varies with particle loading and surface chemistry, and reflects the relative populations of segments constrained or immobilized at the particle-polymer interface. Dielectric measurements, which were used to probe the time-temperature response across the local sub-glass relaxations, indicate no variation in relaxation characteristics with particle loading. Nanocomposite studies were also conducted on rubbery poly(ethylene oxide) networks crosslinked in the presence of MgO or SiO2 nanoparticles. The inclusion of nanoparticles led to a systematic increase in rubbery modulus and a modest positive offset in the measured glass transition temperature (Tα) for both systems. The sizeable increases in gas transport with particle loading reported for certain other rubbery nanocomposite systems were not realized in these crosslinked networks

Politics And Culture Of The Great Plains: An Introduction

In April 1996 the Center for Great Plains Studies at the University of Nebraska-Lincoln sponsored its twentieth interdisciplinary symposium, Politics and Culture of the Great Plains. From papers and presentations by scholars from the United States and Canada, dealing with Indian rights, women\u27s suffrage, education, the economy, elections, social movements, and historical and contemporary personalities, four are presented in this issue of Great Plains Quarterly. Treaty Seven and Guaranteed Representation: How Treaty Rights Can Evolve into Parliamentary Seats deals with relations between sovereign nations-the Blackfoot Confederacy of southern Alberta and the national government of Canada. Kiera Ladner argues that the Indians had a fundamentally different view than national authorities of Treaty Seven. Concerned about rapid westward expansion in the US in the 1870s, Canadian authorities encouraged their own westward expansion. Authorities viewed treaties as a way to secure title to the land and bring the Indians under control, but the tribes intended to protect their land and life style. What is the legal standing and meaning of treaty rights today? How can the tribes maintain peace and good order as they agreed to do in the treaty? Ladner suggests one way: guaranteed representation in Parliament. The indigenous peoples of North America were and continue to be sovereign nations. Agreements negotiated between them and national governments are still valid, and national governments are obligated to honor them, albeit in a contemporary context. Guaranteed parliamentary representation is an intriguing idea, though perhaps unlikely to be implemented. Ladner\u27s essay encourages us to consider this and other alternatives that will enable national governments to fulfill their obligations to North America\u27s first peoples. National boundaries rarely prevent people and ideas from moving in or out. Ideas, of course, are the most mobile. In Liberal Education on the Great Plains: American Experiments, Canadian Flirtations, 1930-1950, Kevin Brooks focuses on the spread of liberal education to American and Canadian universities of the Great Plains in the 1930s and 1940s. He distinguishes between the oratorical tradition, dedicated to inculcating traditional values and insuring social stability, and the philosophical tradition of seeking new knowledge in the hope of improving society. Universities in the Midwest and Prairies sought to make education useful, combining the philosophical liberal education tradition with vocational and professional training. In spite of the strong commitment of the universities in eastern Canada to the oratorical tradition and the recruitment of college educators from these institutions to oversee the development of prairie universities, it was the midwestern model, with its emphasis on the practical as well as the general, that took hold. Brooks argues lack of resources, distance, and the demand that education focus on the practical foreclosed other options. His study suggests that regional identities are sometimes as important as national ones in explaining the spread and adoption of ideas. The study also helps define the Great Plains as a distinct region, where environmental constraints ensure common responses to social problems, in this case sufficient to overcome the power of national identity and national boundaries

C. Comer Makin to Governor Ross Barnett, 29 September 1962

Makin, a veteran, asks Barnett about the staging area and states he can assemble a squad.https://egrove.olemiss.edu/west_union_gov/1094/thumbnail.jp

Effect of Environmental Conditioning on the Properties of Thermosetting and Thermoplastic-Matrix Composite Materials by Resin Infusion for Marine Applications (PREPRINT)

Glass-fibre reinforced polymer (GFRP) laminates were manufactured using Vacuum assisted Resin Transfer Moulding (VaRTM) with a range of thermosetting resins and a novel infusible thermoplastic resin as part of a comprehensive down-selection to identify suitable commercially available resin systems for the manufacture of marine vessels greater than 50 m in length. The effect of immersion in deionised water and in an organic liquid (diesel) on the interlaminar shear strength (ILSS) and glass transition temperature (Tg) was determined. The thermoplastic had the highest Tg of all materials tested and comparable ILSS properties to the epoxy. Immersion in water, however, caused larger reductions in ILSS properties of the thermoplastic compared to the other systems. SEM showed a transition from matrix-dominated failure in the dry condition to failure at the fibre-matrix interface in the wet and organic-wet specimens. The overall performance of the infusible thermoplastic is good when compared to well-established marine resin systems; however, the environmental performance could be improved if the thermoplastic resin is used in conjunction with a fibre sizing that is tailored for use with acrylic-based resin systems

3+1 Approach to the Long Wavelength Iteration Scheme

Large-scale inhomogeneities and anisotropies are modeled using the Long Wavelength Iteration Scheme. In this scheme solutions are obtained as expansions in spatial gradients, which are taken to be small. It is shown that the choice of foliation for spacetime can make the iteration scheme more effective in two respects: (i) the shift vector can be chosen so as to dilute the effect of anisotropy on the late-time value of the extrinsic curvature of the spacelike hypersurfaces of the foliation; and (ii) pure gauge solutions present in a similar calculation using the synchronous gauge vanish when the spacelike hypersurfaces have extrinsic curvature with constant trace. We furthermore verify the main conclusion of the synchronous gauge calculation which is large-scale inhomogeneity decays if the matter--considered to be that of a perfect-fluid with a barotropic equation of state--violates the strong-energy condition. Finally, we obtain the solution for the lapse function and discuss its late-time behaviour. It is found that the lapse function is well-behaved when the matter violates the strong energy condition.Comment: 21 pages, TeX file, already publishe