Consensus guidelines for the management of low back pain recommend that the clinician use contemporary best practice for assessment and treatment, consider biopsychosocial factors and, if chronic, use a multimodal and multi-disciplinary approach. Where guidelines are not followed and basic assessment is inadequate the diagnosis may be compromised and the sequelae of errors compounded. Factors such as a lack of knowledge or recognition of the common structure specific pain referral patterns, poor clinical reasoning, inappropriate referral and predilection for popular management approaches also contribute to mis-diagnosis and mis-management. This report describes two cases of chronic low back pain with lengthy histories of multiple failed interventions to highlight the consequences of focussing on a singular approach to the exclusion of evidence based pathways and the resulting risk of a missed diagnosis. The eventual management to mitigate these problems is reported with the aid of low back pain outcome measures, computer-aided combined movement examination, disability and pain questionnaires and health quality of life surveys.

The internal concentration polarization is recognized as a major obstacle for forward osmosis (FO) membranes to achieve high water flux. Herein, porous substrates with vertical pores are first proposed to be used as supports for fabricating FO membranes in thin film composite structure. The addition of acetone in the aqueous phase facilitates the successful interfacial polymerization on the substrates with vertical pores. Positron annihilation lifetime analyses indicate that the fabricated FO membranes possess thicker and denser selective layer than traditional FO membranes with asymmetric substrates. These novel FO membranes have a low structure parameter, indicating a greatly reduced internal concentration polarization effect. They exhibit an unprecedented water flux up to 93.6 L m−2 h−1 when the selective layer is oriented towards the deionized water feed solution with 2 mol L−1 sodium chloride solution as draw stream. This performance outstands from those FO membranes reported in literatures and available commercially. The results demonstrate that substrates with vertically oriented porous structure are ideal supports for developing FO membranes with minimized or even eliminated internal concentration polarization and ultrahigh water flux.

We evaluated the analytical performance of new estradiol and progesterone assays performed on the Bayer Immuno 1 system. Within-run and between-day CVs for estradiol at concentrations of 116.8-6645.8 pmol/L were < or = 6.4% and for 5.54-103.95 nmol/L progesterone were < or = 7.7%, thus meeting published analytical goals. The detection limits (2 SDs from mean of zero calibrator) were 27.1 pmol/L for estradiol (n = 72 over 20 days) and 0.51 nmol/L for progesterone (n = 47 over 20 days). The assays were linear to 9766 pmol/L and 113.0 nmol/L, respectively. Estradiol results agreed well with the Diagnostic Products Corporation (DPC) assays, except for serum samples from patients receiving estrogen replacement therapy; results for these samples agreed closely with the DPC estradiol-6 assay. The progesterone assay agreed closely with the DPC assay, except for samples from uremic patients. Reference values were estimated by the study of 29 women throughout the menstrual cycle with 15 samples per subject. We concluded that both assays demonstrate suitable precision, linearity, and intermethod agreement to allow their use in the clinical laboratory.

Objectives: To evaluate the performance of the Technicon Immune 1(R) CK-MB mass assay.Design and Methods: The precision was measured using the Bio-Rad Liquichek(TM) CK-MB controls and the Technicon Immune 1(R) SETpoint CK-MB calibrators. The linearity was verified by diluting 9 patient serum samples containing high CK-MB concentrations, and the minimum detectable concentration determined by repetitive analysis of the zero calibrator. The assay was compared with the Johnson & Johnson Vitros(R) CK-MB activity assay using 111 patient serum samples. The reference range was determined using serum samples from 100 healthy adult volunteers.Results: The assay shows within-run CVs varying from 1.5 to 7.5% and between-day CVs from 1.5 to 4.8% for CK-MB concentrations ranging from 3.9 to 99.0 mu g/L. The linearity study gave correlation coefficients greater than 0.9961. There was a very good correlation between mass and activity assays (r=0.985). The reference values were estimated at 0.0-4.2 mu g/L and the minimum detectable concentration at 0.5 mu g/l.Conclusions: The evaluation shows that the Technicon Immune 1(R) GK-MB mass assay has the analytical characteristics suitable for its inclusion in the modern clinical repertoire.