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In this period moroccanoil treatment order frumil 5mg overnight delivery, ideas and patents related to symptoms quit drinking frumil 5mg for sale the radio frequency identification were released 5 medications for hypertension cheap frumil 5 mg mastercard. New applications were successfully introduced treatment 0f ovarian cyst order online frumil, such as fuel dispensing, ski pass systems and vehicle access. Tags were manufactured in the form of thin sticky labels (inlays), equipped with planar antennas, which could be easily attached to the object to be managed. As the technology was spreading worldwide with increasing market penetration, many efforts were directed to develop standards and guidelines to regulate the communication protocols in the different countries. In the last years, the tag performance has been rapidly improving, and costs dropped down. In fact, since tags are intended to label virtually any kind of object, including everyday consumables, their cost must be fairly lower than the cost of the labeled item. The financial, security and safety sector is currently leading the market, exceeding $1. Prediction of chip (solid line) and chipless (dash line) tag price versus global sells for the next years. Specifically, the retail and consumables sector is expected to become the market leader before the end of the current decade. Passive tags are not provided with any independent source of power to activate the integrated circuitry of the transponder. Instead, the power necessary to the transponder operation is delivered by the interrogation signal coming from the reader. The communication between the reader and passive tags is based on the modulated signal backscatter principle, which can be described as follows. The transponder is initially in a condition of good impedance matching with the antenna of the tag, so that it can absorb all the power received from the antenna. Once the transponder is provided with enough energy upon an incoming query signal, it changes its input impedance so that the electromagnetic power is reflected to the antenna and radiated back to the reader. The impedance states are alternated to generate a codified series of reflections, which contains the information requested in the query signal. The absence of batteries, or any other kind of power supply, determines a tremendous advantage in terms of dimensions, simplicity, and cost. Passive tags can be machined in flexible adhesive inlays, with a thickness of few micrometers and a cost of few cents. Active tags are equipped with an embedded power source, usually a battery, in order to provide energy to the tag circuitry and to communicate with the reader. Relying on a dedicated energy source, active tags can perform complex tasks and communicate to very large distances, in the order of hundreds of meters, by means of sophisticated and noise-robust phase-shift modulations. Contrarily to passive tags, which can only respond to a request, active tags can start a communication to the reader, as may be requested in specific applications. However, active tags suffer from the increased complexity, dimensions and cost, which is in the order of tens of dollars. The presence of a fully-equipped radio, a battery and, in some cases, two separate antennas, makes impracticable the manufacturing of thin, flexible labels. The expected lifetime of active tags depends upon the battery duration, and in many cases the whole tag must be replaced once the battery is exhausted. Moreover, being provided with a fully-equipped transmitting radio, active tags must be subjected to certification according to the regulatory standards of each country. This solution is widely employed in tags equipped with sensors, which need energy to continuously collect and store data, but are designed to minimize their complexity and required power, so that an active radio transmitter is not included. Therefore, whereas tag antennas of low frequency systems are much smaller than the wavelength, tag antennas of high frequency systems are comparable in size to a wavelength. In the first case, the tag antenna is essentially a small coil interacting with the magnetic field stored in the vicinity of the reader antenna, a mechanism often referred as inductive coupling. Rather than modeling the tag-reader interaction by means of incident and reflected waves, the system can be thought as a magnetic transformer, where the current flowing in one element induces a voltage across the other element. To provide intense magnetic fields in the surroundings of the reader antenna, large loop structures are usually employed. On the other hand, when the antenna size is comparable with the wavelength, the coupling mechanism is radiative coupling. Under this condition, the tag and reader antennas communicate by means of traveling electromagnetic waves, being one antenna located in the far-field zone of the other antenna. A clear advantage of radiative coupling over inductive coupling is the distance of operation. While the near fields stored in the vicinity of the antenna decay with the cube of the distance, providing a detection zone whose dimensions are comparable to the antenna size, the radiated fields attenuate with the square of the distance, so that systems relying on radiative coupling can operate to much larger distances. Contrarily, inductive coupling allows much smaller antenna sizes, which is categorically required by many applications. The choice of a frequency band involves a series of advantages and drawbacks, mainly related to the physical behavior of the electromagnetic fields. Typical applications include animal tracking, access control and item level identification of pharmaceutical products. However, being the operation frequency much higher, a smaller number of turns is required to produce sufficient voltage across the tag, generally in the order of only 5 or 6 turns. Although many efforts have led to several tag designs optimized to operate in proximity of liquids, or to be attached on metallic surfaces, such solutions suffer from increased dimensions and cost with respect to the general-purpose tags. These include supply chain and inventory management, parking access control, baggage tracking and asset tracking, among others. Planned applications include smart-shelves and fitting rooms, fast payment and anti theft systems in retail stores, and significant contribution to the abovementioned Internet of Things. Several communication standards and regulations are available, and sometimes the tags are designed to be compatible with other existing standards. In the future, it may provide extremely low cost tags directly printable on the objects, replacing barcodes with drastically improved functionality. The exposition continues with an introduction to passive tag antenna design, detailing the application requirements and providing an overview of the most common solutions employed in commercial tags. The main performance indicators of passive tags are then introduced, along with the measurement setups which have been used for obtaining the experimental data presented throughout this work. Finally, the state of the art of on-metal passive tag design is discussed, specially focusing on the solutions aimed at reducing the tag thickness (low-profile tags) and dimensions. A third component, often necessary as a structural support, is the dielectric substrate. The current market offers a variety of tags optimized for being mounted on glass, or attached onto object containing liquids, or worn by persons. Special tags designed to be mounted on metallic surfaces, or to be attached to objects containing metallic parts, are available today. These are cost-effective tags which, rather than being optimized for a specific application, are designed to operate in a wide number of applications. One clear advantage of general-purpose tags is that the user can buy a large number of the same tag model, and use it for tagging different items. Obviously, these tags may suffer from severe performance degradation when attached to some objects containing liquids or metals [10], so that prior information about each tagged items is required to ensure good results. When the tag is manufactured as a label in highly productive assembling lines, the unpackaged chip is directly attached to the antenna, usually by means of flip chip techniques. This solution allows fast, efficient and reel-to-reel production of very thin and reliable inlays, but also needs a high initial investment. In fact, with the global commerce and mass production constantly increasing each year, the problem of uniquely identifying each physical item anywhere in the world, for all time, is increasingly challenging. This version of the code allows identifying 268 million different companies, each disposing of 16 million product types with 68 billion serial numbers available for each type. Each class provides a set of functions optimized to perform activities related to a certain application field. Advanced functions, often related to the privacy of consumers, allow for example to disable or “kill” the tags after their functional cycle has been complied. Unfortunately, being the transceiver a non-linear load with a strong reactive component, its input impedance varies upon frequency, and also depends on the bias point of the device, i.
Considerable regional disparities were recorded symptoms you need glasses discount 5mg frumil amex, with a higher proportion of admissions and surgical interventions in the north of the country and in Brussels treatment improvement protocol purchase line frumil. The limits inherent to medications with dextromethorphan purchase generic frumil line these estimates are medicine chest buy frumil paypal, on the one hand, the absence of specificity of the nomenclature codes for lumbar pain (especially chronic pain) and, on the other hand, the lack of many other sources of information on costs (such as consultations, hospitalization and other items of expenditure). According to the longitudinal data of the Socialist Mutuality, the approximate annual medical cost connected with the care per patient suffering from chronic low back pain and for whom medical imaging codes have been invoiced is 922. This estimate is also limited by several factors: the method used to select patients suffering from chronic lumbar pain, the absence of data relating to consultations, the lack of accuracy in terms of the anatomical region to which certain procedures are related and the unknown time interval between the diagnosis and a possible intervention. This study concluded that the total direct medical cost of chronic low back pain in Belgium varies from 81 to 167 million euros. The total amount could therefore be prudently estimated at between 270 million and 1. Grave consequences for social security While the indirect costs cannot be accurately estimated, an analysis of the occupational medicine databases shows that the effects of chronic low back pain on society and on industry are harmful indeed. This type of disability is more prevalent among male employees with the status of manual workers who have recently joined the company. As a result, one in every 20 patients is assessed as being permanently unable to return to work. In 15% of cases, the patient can go back to work provided the work is adapted, a fact that highlights the crucial role of the occupational physician when it comes to caring for low back pain. The consequences are staggering: of the workers presenting an acute episode of low back pain connected with occupational accidents 72% were absent from work, and of this total figure 8,2% were absent for three months or more. A total of 62,4% and 95% of workers are temporarily or permanently disabled respectively. The sectors most affected are the timber industry, the construction industry and the metalworking industry. The construction and health/social sectors have the highest figures for permanent disability. Furthermore, the data reveal the geographic disparities, as the number of permanent partial disabilities is higher in Wallonia than in Flanders. Overexertion is the most frequently declared cause of accidents, while falling is the most frequent cause of injuries leading to permanent disability. The primary role of these medical practitioners must be to inform workers: backache is a frequent disorder; certain posts and certain positions involve more risks; acute back pain often resolves itself spontaneously (90% within six weeks); it is important to keep active in spite of the pain. Although the physical constraints involved in work play a role at an etiological level, psychosocial factors (such as stress, anxiety or dissatisfaction with work) affect the seriousness of the ongoing disorder and the likelihood of chronicity. The second role of these physicians is to promote prevention strategies aimed at preventing chronicity. The literature gives evidence in favour of back schools (in the workplace, including an exercise component) and multidimensional or multidisciplinary interventions (see above). A multidisciplinary approach based on a combination of a program of exercises and psychological and/or social care is particularly beneficial. Occupational physicians and advisory physicians therefore bear some responsibility for the care of workers disabled by low back pain, along with family doctors. The physician should ideally reduce the period of disability by advising the patient to pursue his normal activities. In the event of recurrent or constant lumbar pain, an analysis of the "yellow flags" will identify workers at risk of chronicity (psychological problems or depression). In this regard, a return to work program backed up by cooperation between the curative sector and the occupational medicine sector is beneficial as it encourages the worker to return to work and reduces the number of days lost. The first basic step in this care program is to maintain normal activities as much as possible. Furthermore, exercise programs play a positive role in re-education and multidisciplinary care is beneficial. Many noninvasive treatments that are currently applied are based on scanty evidence or do not work at all. Based on the existing studies, we cannot yet define precisely the efficacy or the potential side effects of many invasive techniques (injections). Due to a lack of data in Belgium, it is not possible to evaluate the extent of chronic low back pain with any accuracy. The available databases provided by occupational medical services and by the mutuality sector do not provide a means of systematically identifying these workers/patients or monitoring them in the care circuit. In addition, these databases do not yield any hypotheses on the geographic disparities that are observed. The evaluation of medical costs that we propose in this study is largely underestimated. A proper evaluation would require a data collection program geared specifically to the epidemiology and to the costs connected specifically with that particular pathology. Given that the indirect consequences of the pathology account for the bulk of the cost, occupational physicians and advisory physicians have a crucial role to play when it comes to helping workers get back to work as quickly as possible (in cooperation with the family doctor), bearing in mind that the data demonstrate that prolonged absence can lead to chronicity. In cases of chronic low back pain, it is crucial for the patient to get back to work as quickly as possible. Prescribing useless tests and applying inappropriate treatments maintains the chronicity of the backache and does the patient more harm than good. The respective tasks and responsibilities of the occupational physician and of the advisory physician must be redefined: their role in preventing chronicity must be strengthened, as the rapid reintegration of workers suffering from chronic low back pain is a priority for the authorities. From a policy standpoint, they do not provide a means of properly monitoring the consequences of a societal problem such as low back pain. A first part analyses the evidence-based literature on the diagnosis and treatment. The second part analyses the available databases in Belgium in order to assess the size of this public health problem and its related costs. The literature review in part I summarizes the evidence based literature sources currently available. It aims to serve as a clinical practice guideline to help primary care and specialized practitioners involved with chronic low back pain. This part mainly searched for the available evidence in guidelines, meta-analyses and systematic reviews. Hence, it should not be considered as an exhaustive list of all available evidence on all diagnostic and therapeutic procedures. No specific search has been conducted on the safety aspects of the procedures and only the most common ones that have been described in the selected references are summarized in this report. Those literature reviews allow appraising to what extent Belgian medical care for chronic low back pain is based on an evidence-based approach. These decisions can relate to multiple facets as for example the availability of databases, their content, the quality and organisation of care. Nielens Important preliminary remarks this report focuses on evaluation and treatment of patients with non-specific chronic low back pain (lasting for more than three months) with or without nerve root/radicular pain. Less common origins of chronic low back pain such as spinal stenosis, spondylolisthesis, spinal tumor or infection are not specifically addressed in this report. Chronic low back pain is a symptom: the different possible etiologies are voluntary not cited. Numerous other references have been consulted and added in this systematic literature search, in particular if they were more recent or addressed specific techniques. Recommendations based on the available evidence are also be included in this report. The detailed searching methodology and references selection after critical appraisal are described in the appendices. Likewise, it is generally admitted that a thorough physical examination including a well-conducted history-taking should also be repeated in the chronic stage. For instance, pain localization must be taken into account, as it often constitutes the first clinical information that may lead to suspect radicular pain (see next section on red flags). Evidence Some tools have been developed to assess pain characteristics (Visual Analogic Scale, Dallas). Koes added the following red flags suggesting radicular pain due to nerve root 6 compression: x Unilateral leg pain > low back pain, x Pain radiating to foot or toes, x Numbness and parenthesis of same distribution, x Passive Straight Leg Raise test (see below) inducing more leg pain than back pain, x Localized neurological deficit (limited to one nerve root).
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Both of these statements must be interpreted innitesimally; we shall learn to treatment modality definition buy frumil now do so in the discussion below medicine of the wolf order frumil 5mg with amex. Holomorphic functions enjoy both properties: Let f be holomorphic in a neighborhood of P C symptoms youre pregnant order 5mg frumil otc. The matrix J (P) is of course a special orthogonal matrix (that is treatment for shingles purchase 5 mg frumil overnight delivery, its rows 2 form an orthonormal basis of R, and it is oriented positively—so it has determinant 1). Thus we see that the derivative of our mapping is a rotation J (P) (which preserves angles) followed by a positive “stretching factor” h(P) (which also preserves angles). Of course a rotation stretches equally in all directions (in fact it does not stretch at all); and our stretching factor, or dilation, stretches equally in all directions (it simply multiplies by a positive factor). In fact the second characterization of conformality (in terms of preserva tion of directed angles) has an important converse: If (2. Thus a function that is conformal (in either sense) at all points of an open set U must possess the complex derivative at each point of U. Or, by Goursat’s theorem, 1 it would then follow that the function is holomorphic on U, with the C condition being automatic. Write down the Jacobian matrix of f at P, thought of as a 22 real matrix operator. Verify directly (by imitating the calculations presented in this section) that this Jacobian matrix is the composition of a special orthogonal matrix and a dilation. Discuss, in physical language, why the surface motion of an incom pressible uid ow should be conformal. Verify that the function g(z)=z has the property that (at all points not equal to 0) it stretches equally in all directions, but it reverses angles. Explain why , no matter how smooth or otherwise well behaved, could not possibly be conformal. Your input for this function will be as follows: >> syms x y real >> syms z complex >> z=x+i*y >> f = z^2 >> v1 = [1 1] >> v2 = [0 1] >> P=3+2*i >> conf(f,v1,v2,P) 2 In this sample input we have used the function f(z)=z and vectors v1 = h1, 1i and v2 = h0, 1i. Calculate the directional derivatives at P of v v in the directions w1 =(1, 0) and w2 =(1/ 2, 1/ 2). Calculate the angle between the directional derivative of at P in the direction w1 and the directional derivative of at P in the direction w2. Let D = D(0, 1) be the unit disc and let f be a nonvanishing, holomorphic function on D. Another way to think about the logarithm is as follows: Write i argw log w = log |w|e = log |w| + iarg w. The principal branch of the logarithm is that for which the argument satises 0 <2. We have selected that value for the argument that lies between 0 and 2 so that we may obtain the principal branch. We conclude this section by noting that in each of the three examples we may check our work: 1+2ki 1 2ki e = e · e = e; v v v log 2+i[/4+2k] log 2 i[/4+2k] i/4 e = e · e = 2 · e =1+i; and log3+i log3 i e = e · e =3· (1) = 3. Calculate the complex logarithm of each of the following complex num bers: (a) 3 3i v (b) 3+i v v (c) 2 2i 2. Calculate the principal branch of the logarithm of each of the following complex numbers: (a) 2 + 2i v (b) 3 3 3i (c) 4+4i (d) 1 i (e) i (f) 1 v (g) 1 + 3i v (h) 2 2 2i 1i 1i i 4i 3. Write a MatLab routine to nd the principle branch of the logarithm of a v v given complex number. It is not possible to give a succinct, unambiguous denition to the logarithm function on all of C . All of the principal results about holomorphic functions stem from this simple integral formula. We shall spend a good deal of our time in this text studying the Cauchy theorem and its consequences. In fact it turns out that the Cauchy integral theorem, properly construed, is little more than a restatement of Green’s theorem from calculus. An important converse of Cauchy’s theorem is called Morera’s theorem: Let f be a continuous function on a connected open set U C. In the statement of Morera’s theorem, the phrase “every simple, closed curve” may be replaced by “every triangle” or “every square” or “every circle. A curve:[a, b] > C is said k to be piecewise C if [a, b]=[a0,a1] [a1,a2] ···[am1,am] (3. When we deform, and cut and paste, curves then k the curves created will often by piecewise C. We can be condent that we can integrate along such curves, and that the Cauchy theory is valid for such curves. But it is of denite interest—and useful later—to know that Morera’s theorem is true for functions that are only continuous. Example 33 Let U be the region consisting of the disc {z C: |z| < 2} with the closed disc {z C: |z i| < 1/3} removed. The requirement that we impose on these curves is that they do not surround any holes in U—in other words, the curve formed with followed by (the 3. Note that, in order for this statement to be valid, the curve must remain inside the region of holomorphicity U of f while it is being deformed, and it must remain a closed curve while it is being deformed. Now let us examine the dierence of the integrals over the two curves—see Figure 3. We see that this dierence is in fact the integral of the holomorphic function f over a closed curve that can be continuously deformed to a point. A topological notion that is special to complex analysis is simple con nectivity. We say that a domain U C is simply connected if any closed curve in U can be continuously deformed to a point. Simple connectivity is a mathematically rigorous condition that corresponds to the intuitive notion that the region U has no holes. If U is simply connected, and is a closed curve in U, then it follows that can be continuously deformed to lie inside a disc in U. Likewise, on a simply connected region U, Cauchy’s integral formula (to be developed below) applies to any simple, closed curve that is oriented counterclockwise and to any point z that is inside that curve. It tells us that we can express the value of a holomorphic function f in terms of a sort of average of its values around the boundary. This assertion is really quite profound; it turns out that the formula is key to many of the most important properties of holomorphic functions. Thus we may apply Cauchy’s theorem to see that I g d =0 D(0,r) or I f z d =0. We know that the integral of g over any curve that does not surround z must be zero—by the Cauchy integral theorem. And the integral over a curve that does pass through or surround z will therefore also be zero by a simple limiting argument. It is convenient to use deformation of curves to move the boundary D(0,r)toD(z,), where >0 is chosen so small that D(z,) D(0,r). Thus the Cauchy-Goursat theorem is swept under the rug: holomorphic functions are as smooth as can be, and we can dierentiate them at will. Let:[0, 1] > U be a simple, closed curve that can be continuously deformed to a point inside U. If f is holomorphic on U and z lies in the region interior to , then I 1 f f(z)= d. Conrm the statement of the Cauchy integral theorem for this f and this by actually calculating the appropriate complex line integral. Let (t) be the counterclockwise 2 2 oriented, square path for which they are the vertices. Verify the con clusion of the Cauchy integral theorem for this path and the function 2 f(z)=z z. The Cauchy integral theorem fails for the function f(z) = cot z on the annulus {z C:1< |z| < 2}. Calculate the relevant complex line integral and verify that the value of the integral is not zero. Let u be a harmonic function in a neighborhood of the closed unit disc D(0, 1) = {z C: |z|1}.
For instance symptoms hypothyroidism 5mg frumil amex, the presence of red flag such as loss of weight medicine wheel native american frumil 5 mg free shipping, general unwellness medicine world quality 5mg frumil, should lead to medicine prescription buy frumil american express test biology. Evidence 2 Cost B13 related one systematic review of 36 studies that evaluated the accuracy of history-taking, physical examination and erythrocytes sedimentation in diagnosing low 35 back pain in general practice. The review found that few of the studied signs and symptoms seemed to provide valuable diagnosis. The combined history and the erythrocytes sedimentation rate had relatively high diagnostic accuracy in vertebral 2 cancer. Some imaging techniques (fluoroscopic guidance) may also be used as an aid in the context of invasive therapeutic procedures: those techniques will be addressed in the following sections. The Recommandations du Consilium Radiologicum Belge (currently being revised) are based on a European experts consensus (Radioprotection 118: recommandations en matiere de prescription de limagerie medicale de la Commission Europeenne). Moreover, conventional radiography is not a good screening procedure for the suspicion of compression fractures, cancer and metastases, as its sensitivity is too low. Degeneration, defined by the presence of disc space narrowing, osteophytes, and sclerosis, turned out to be associated with non specific low back pain, but odds ratio were low, ranging from 1. Advanced imaging should be reserved for patients who are being considered for surgery or those in whom systemic disease is strongly suspected. Belgian Consilium Radiologicum recommendations recall that degenerative changes that can be seen on plain lumbosacral films are frequent and not specific. Those recommendations also state that conventional radiography should only be systematically obtained in patients below the age of 20 and older than 55 years old. Discography has been proposed as a diagnostic tool, as it allows imaging degenerative discs and as it may also elicit pain during intra-discal injection, which is generally interpreted as the disc acting as a pain generator (so-called discogenic pain). There is moderate-quality evidence that discography is not a reliable procedure for the diagnosis of common chronic low back pain. One systematic review on invasive techniques concluded that there are inherent limitations in the accuracy of all diagnostic tests, 7 including discography. The review of Carragee and Hannibal reported that 73% and 69% of discs with a high intensity zone were positive on discography in symptomatic and asymptomatic individuals respectively. However, these references use the pathological disc morphology as gold standard: this may be a major methodological flaw. While the accuracy of discography as an imaging test is high, with high specificity and sensitivity for the diagnosis of disc degeneration, the key question with discography remains whether this test is accurate for the diagnosis of discogenic pain as the relationship between degenerative changes and pain is weak. Finally, it must also be underlined that Shah is also one of the authors of the guideline of 61 the American Society of Interventional Pain Physicians and is a member of this Society. Most of the members of the American Society of Interventional Pain Physicians are more favorable than other authors about the effectiveness of invasive diagnostic and therapeutic procedures. Safety of discography the complications cited by Boswell include septic discitis, subdural abscess, spinal cord injury, epidural and prevertebral abscess. The ionizing radiation associated with one conventional lumbar radiograph is equivalent to that of 15 radiographic examinations of the thorax or 63 the average ionizing radiation experienced from all other sources for 8 months. Other more recently developed tests such as Laser-evoked potentials studies and quantitative sensory testing are however seldom implemented in more complex cases (for instance, chronic pain in the context of so-called failed back surgery syndrome). Our additional search finds two systematic reviews on surface 76, 77 electromyography. Nerve conduction examinations include studies of motor nerve conduction, sensory nerve conduction, late responses (F waves) and reflexes (H reflex). It is generally used in experimental studies, in order to examine global trunk muscle activation or muscle 2 fatigue characteristics. Noteworthy, most of such techniques may also be therapeutic as well as diagnostic, as corticosteroids are generally injected along with anesthetizing drugs. When pain is alleviated after such a facet block, it is hypothesized that pain origin is located in the injected facet joint(s). For instance, the facets are thought to be the pain generators in the so-called « facet syndrome ». It must be noted that steroids are also often injected along with the anesthetic drug. Diagnostic blocks of a facet or zygoapophyseal joint are proposed to subgroups of patients suffering with chronic spinal pain eligible to undergo commonly utilized and 61, 2 effective interventional technique or subjects experiencing more than 3 months of chronic spinal pain of sufficiently severe intensity to warrant further investigations or justify referral spinal/spine specialist, and who add failed adequate trial of conservative 87 management with medications, physical therapy, psychological interventions. Facet or zygoapophyseal joints have been implicated as the source of chronic spinal pain in 15% to 45% of patients with chronic low back pain. The reliability of the diagnosis with clinical history, physical examination and medical imaging is poor. Based on 9 good-quality studies in selected populations (failed conservative treatments, no neurological signs, severe pain often more than 6 months of duration) with facet joint injection, the prevalence of facet syndrome is 15 to 45%. Accuracy must be compared with a "gold" or criterion standard that can confirm presence or absence of a disease. There is, however, no available gold standard, such as biopsy, to measure presence or absence of pain. Hence, there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections. Confirmation by others studies in others sites would be necessary before generalizing such favorable conclusions. Noteworthy selective nerve root blocks are sometimes proposed to better define the involved nerve root before invasive therapeutic procedure such as surgery or injection. Although major complications of selective nerve root blocks have been reported in the literature, the safety of such techniques remains largely unknown. Evidence 61 One systematic review identified only one practice guideline (Boswell 2005 based on 88 North et al) and some low-quality studies. A prospective randomized study (North cited in Boswell) examined the specificity and sensitivity of a battery of anaesthetic local blocks. They compared it to a sham procedure consisting of a lumbar subcutaneous injection of 3 ml of 0,5% bupivacaine. Safety and complications Case reports of complications such as dural puncture, infection, intravascular injection, air embolism, vascular trauma, particulate embolism, epidural haematoma, neural 61 damage are found in the literature. The quality of evidence supporting selective nerve root block as a valid and reliable procedure to diagnose radicular pain due to nerve root involvement is low. Hence, physical fitness evaluations are sometimes implemented during physical reconditioning programs to monitor the gains achieved by the patients undergoing such programs. Physical fitness is generally defined as a set of attributes that people have or achieve that 90 relates to the ability to perform physical activity. Thorough physical fitness evaluation should thus theoretically encompass assessment of all components. Evidence No evidence on physical capacity/fitness evaluation is available in the selected 89 references. It may only be hypothesized that sub maximal testing procedures are probably more appropriate, as they should theoretically be better tolerated and less likely to be influenced by pain, fear of pain and other non-physiological factors in such patients. Most commonly used methods to evaluate trunk muscle strength and endurance may be classified into non-instrumented testing procedures (Sorensen, Ito tests) and instrumented methods. Our additional search failed to identify any good-quality reference addressing bed rest. Safety of bed rest It is well known that bed rest leads to numerous adverse effects such as muscle atrophy, joint stiffness, bone mass loss, decubitus, deep venous thrombosis, alteration of 98, 97 general health. They consist in rigid (reinforced leather, thermoplastic, plaster) or semi-rigid (soft leather, elastic materials) belts that must be worn permanently or during specific physical activities following medical advice. The rationale is that lumbar supports reduce mechanical constraints on the lumbar spine leading to pain and inflammation reduction. There is conflicting evidence that lumbar supports are more effective than no treatment. Adverse effects (skin lesions, gastro-intestinal disorders, elevated blood pressure and heart rate and trunk muscle wasting) have been reported. Lumbar supports versus no treatment 101 the Cochrane systematic review showed that There is limited evidence that lumbar 2 supports are more effective than no treatment. Lumbar supports versus other interventions 101 the Cochrane review concludes that It is still unclear if lumbar supports are more effective than other interventions for the treatment of low back pain. There is conflicting evidence that massage is superior to spinal manipulative therapy and to Transcutaneous Electrical Nerve Stimulation. In these studies, massage is a control intervention to which another therapeutic intervention is compared. Massage was compared to an inert treatment (sham laser), in one study that showed that massage was superior, especially if given in combination with exercises and education. One study comparing two different techniques of massage concluded in favor of acupuncture 116 massage with classic (Swedish) massage.