Efficacy of interspinous device versus surgical decompression in the treatment of lumbar spinal stenosis: a modified network analysis.

Study designSystematic review using a modified network analysis.ObjectivesTo compare the effectiveness and morbidity of interspinous-device placement versus surgical decompression for the treatment of lumbar spinal stenosis.SummaryTraditionally, the most effective treatment for degenerative lumbar spinal stenosis is through surgical decompression. Recently, interspinous devices have been used in lieu of standard laminectomy.MethodsA review of the English-language literature was undertaken for articles published between 1970 and March 2010. Electronic databases and reference lists of key articles were searched to identify studies comparing surgical decompression with interspinous-device placement for the treatment of lumbar spinal stenosis. First, studies making the direct comparison (cohort or randomized trials) were searched. Second, randomized controlled trials (RCTs) comparing each treatment to conservative management were searched to allow for an indirect comparison through a modified network analysis approach. Comparison studies involving simultaneous decompression with placement of an interspinous device were not included. Studies that did not have a comparison group were not included since a treatment effect could not be calculated. Two independent reviewers assessed the strength of evidence using the GRADE criteria assessing quality, quantity, and consistency of results. The strengths of evidence for indirect comparisons were downgraded. Disagreements were resolved by consensus.ResultsWe identified five studies meeting our inclusion criteria. No RCTs or cohort studies were identified that made the direct comparison of interspinous-device placement with surgical decompression. For the indirect comparison, three RCTs compared surgical decompression to conservative management and two RCTs compared interspinous-device placement to conservative management. There was low evidence supporting greater treatment effects for interspinous-device placement compared to decompression for disability and pain outcomes at 12 months. There was low evidence demonstrating little to no difference in treatment effects between the groups for walking distance and complication rates.ConclusionThe indirect treatment effect for disability and pain favors the interspinous device compared to decompression. The low evidence suggests that any further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. No significant treatment effect differences were observed for postoperative walking distance improvement or complication rates; however, findings should be considered with caution because of indirect comparisons and short follow-up periods

Calculated performance, stability and maneuverability of high-speed tilting-prop-rotor aircraft

The feasibility of operating tilting-prop-rotor aircraft at high speeds is examined by calculating the performance, stability, and maneuverability of representative configurations. The rotor performance is examined in high-speed cruise and in hover. The whirl-flutter stability of the coupled-wing and rotor motion is calculated in the cruise mode. Maneuverability is examined in terms of the rotor-thrust limit during turns in helicopter configuration. Rotor airfoils, rotor-hub configuration, wing airfoil, and airframe structural weights representing demonstrated advance technology are discussed. Key rotor and airframe parameters are optimized for high-speed performance and stability. The basic aircraft-design parameters are optimized for minimum gross weight. To provide a focus for the calculations, two high-speed tilt-rotor aircraft are considered: a 46-passenger, civil transport and an air-combat/escort fighter, both with design speeds of about 400 knots. It is concluded that such high-speed tilt-rotor aircraft are quite practical

Controlling for performance capacity confounds in neuroimaging studies of conscious awareness

Studying the neural correlates of conscious awareness depends on a reliable comparison between activations associated with awareness and unawareness. One particularly difficult confound to remove is task performance capacity, i.e. the difference in performance between the conditions of interest. While ideally task performance capacity should be matched across different conditions, this is difficult to achieve experimentally. However, differences in performance could theoretically be corrected for mathematically. One such proposal is found in a recent paper by Lamy, Salti and Bar-Haim [Lamy D, Salti M, Bar-Haim Y. Neural correlates of subjective awareness and unconscious processing: an ERP study. J Cognitive Neurosci 2009,21:1435-46], who put forward a corrective method for an electroencephalography experiment. We argue that their analysis is essentially grounded in a version of High Threshold Theory, which has been shown to be inferior in general to Signal Detection Theory. We show through a series of computer simulations that their correction method only partially removes the influence of perfor- mance capacity, which can yield misleading results. We present a mathematical correction method based on Signal Detection Theory that is theoretically capable of removing performance capacity confounds. We discuss the limitations of mathemati- cally correcting for performance capacity confounds in imaging studies and its impact for theories about consciousness

Genome-wide detection of segmental duplications and potential assembly errors in the human genome sequence

BACKGROUND: Previous studies have suggested that recent segmental duplications, which are often involved in chromosome rearrangements underlying genomic disease, account for some 5% of the human genome. We have developed rapid computational heuristics based on BLAST analysis to detect segmental duplications, as well as regions containing potential sequence misassignments in the human genome assemblies. RESULTS: Our analysis of the June 2002 public human genome assembly revealed that 107.4 of 3,043.1 megabases (Mb) (3.53%) of sequence contained segmental duplications, each with size equal or more than 5 kb and 90% identity. We have also detected that 38.9 Mb (1.28%) of sequence within this assembly is likely to be involved in sequence misassignment errors. Furthermore, we have identified a significant subset (199,965 of 2,327,473 or 8.6%) of single-nucleotide polymorphisms (SNPs) in the public databases that are not true SNPs but are potential paralogous sequence variants. CONCLUSION: Using two distinct computational approaches, we have identified most of the sequences in the human genome that have undergone recent segmental duplications. Near-identical segmental duplications present a major challenge to the completion of the human genome sequence. Potential sequence misassignments detected in this study would require additional efforts to resolve

Fiscal sustainability: an empirical investigation in Sarawak

This paper examines the fiscal sustainability condition for Sarawak during 1971 to 2004. We also split the sample period into the pre-crisis (1971-1996) to investigate the disparities between the two empirical samples. Empirical validation from the time series analysis finds that government revenue, government expenditure and Gross domestic Product (GDP) are cointegrated, which provides some support for the position that Sarawak’s budget deficit is sustainable in the long run in both sampling periods. The results also found support for coefficient of expenditure being unity in both periods. This finding suggests that reducing the size of government spending may improve fiscal budget deficits without having to undergo changes in the overall strategy

The Use of Gene Expression Analysis and Proteomic Databases in The Development of a Screening System To Determine The Value of Natural Medicinal Products

A rapid throughput screening system involving gene expression analysis was developed in order to investigate the potential of bioactive chemicals contained in natural health products as effective drug therapy, in particular the ability of these chemicals to alleviate the inflammatory response in human airway epithelial cells. A number of databases were searched to retrieve the information needed to properly analyze the gene expression profiles obtained. The gene expression of human bronchial epithelial cells infected with rhinovirus and/or exposed to platelet activating factor was analyzed. Following analysis of the gene expression data the total number of expressed proteins that may potentially act as a marker for monitoring the modulation of airway inflammation was narrowed to 19. Further studies will involve selecting antibodies for these proteins, culturing airway epithelial cells in the presence of extracts of natural health products, extracting the proteins and identifying them by western blot analysis

Synthetic genome recoding: new genetic codes for new features.

Full genome recoding, or rewriting codon meaning, through chemical synthesis of entire bacterial chromosomes has become feasible in the past several years. Recoding an organism can impart new properties including non-natural amino acid incorporation, virus resistance, and biocontainment. The estimated cost of construction that includes DNA synthesis, assembly by recombination, and troubleshooting, is now comparable to costs of early stage development of drugs or other high-tech products. Here, we discuss several recently published assembly methods and provide some thoughts on the future, including how synthetic efforts might benefit from the analysis of natural recoding processes and organisms that use alternative genetic codes