The Reliability of Red Flags in Spinal Cord Compression

Background: Acute low back pain is a common cause for presentation to the emergency department (ED). Since benign etiologies account for 95% of cases, red flags are used to identify sinister causes that require prompt management. Objectives: We assessed the effectiveness of red flag signs used in the ED to identify spinal cord and cauda equine compression. Patients and Methods: It was a retrospective cohort study of 206 patients with acute back pain admitted from the ED. The presence or absence of the red flag symptoms was assessed against evidence of spinal cord or cauda equina compression on magnetic resonance imaging (MRI). Results: Overall, 32 (15.5%) patients had compression on MRI. Profound lower limb neurologic examination did not demonstrate a statistically significant association with this finding. The likelihood ratio (LR) for bowel and bladder dysfunction (sensitivity of 0.65 and specificity of 0.73) was 2.45. Saddle sensory disturbance (sensitivity of 0.27 and specificity of 0.87) had a LR of 2.11. When both symptoms were taken together (sensitivity of 0.27 and specificity of 0.92), they gave a LR of 3.46. Conclusions: The predictive value of the two statistically significant red flags only marginally raises the clinical suspicion of spinal cord or cauda equina compression. Effective risk stratification of patients presenting to the ED with acute back pain is crucial; however, this study did not support the use of these red flags in their current form

On the resolution of cosmic coincidence problem and phantom crossing with triple interacting fluids

We here investigate a cosmological model in which three fluids interact with each other involving certain coupling parameters and energy exchange rates. The motivation of the problem stems from the puzzling `triple coincidence problem' which naively asks why the cosmic energy densities of matter, radiation and dark energy are almost of the same order of magnitude at the present time. In our model, we determine the conditions under triple interacting fluids will cross the phantom divide.Comment: 22 pages, 6 figures, to appear in Eur. Phys. J. C (2009

Not to Knot a Catheter. Case Report of the Knotting of a Suprapubic Catheter

A 20-month-old boy, who underwent left nephrectomy, had a suprapubic catheter inserted that knotted within the bladder. This case report identifies possible causes for such occurrences and how best to manage them

Corporate Social Responsibility and Islamic Financial Institutions (IFIs): Management Perceptions from IFIs in Bahrain

Islamic finance is gaining greater attention in the finance industry, and this paper analyses how Islamic financial institutions (IFIs) are responding to the welfare needs of society. Using interview data with managers and content analysis of the disclosures, this study attempts to understand management perceptions of corporate social responsibility (CSR) in IFIs. A thorough understanding of CSR by managers, as evident in the interviews, has not been translated fully into practice. The partial use of IFIs’ potential role in social welfare would add further challenges in the era of financialisation

Cosmic coincidence problem and variable constants of physics

The standard model of cosmology is investigated using time dependent cosmological constant $\Lambda$ and Newton's gravitational constant $G$. The total energy content is described by the modified Chaplygin gas equation of state. It is found that the time dependent constants coupled with the modified Chaplygin gas interpolate between the earlier matter to the later dark energy dominated phase of the universe. We also achieve a convergence of parameter $\omega\to-1$, with minute fluctuations, showing an evolving $\omega$. Thus our model fairly alleviates the cosmic coincidence problem which demands $\omega=-1$ at present time.Comment: 27 pages, 15 figure

Synthesis and characterization of bubble wrap-like hollow barium silicate–carbonate nanospheres for the epoxidation of styrene

Novel porous bubble wrap-like hollow barium silicate–carbonate nanospheres were successfully prepared at a barium/CTAB molar ratio of 0.75 and 1.00. The average pore size, BET surface area and total pore volume of the most catalytically active catalyst in the epoxidation of styrene, 1.00BaMST were 5.0 nm, 42 m2 g−1 and 0.0771 cm3 g−1, respectively. The styrene epoxidation reaction was carried out using H2O2 as an oxidant. Barium silicate and carbonate groups detected on the catalyst’s surface are proposed to activate the H2O2 and selectively oxidize the styrene to styrene oxide. The 1.00BaMST achieved 63.3% of styrene conversion and 77.8% of epoxide selectivity at mild conditions (3 h, 60 ◦C). The reaction energy barrier was calculated to be 17.3 kJ mol−1