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Background context The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016. PURPOSE The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. Study design This is a guideline summary review. Methods This guideline is the product of the Low Back Pain Work Group of NASS’ Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors. Results Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. Conclusions The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx

No solutions exist that enhance Open Shortest Path First (OSPF) network system survivability against link state advertisement (LSA) falsification attacks. Although the OSPF LSA falsification vulnerability has been researched previously, there has been no focus on OSPF network system survivability. Previous research consists of oSPF attack analysis, OSPF attack prevention methodologies, and the development of OSPF vulnerability testing tools. This research presents a redundant network system architecture that can utilize failover between the OSPF and Enhanced Interior Gateway Routing Protocol (EIGRP) dynamic routing protocols to maintain host-to-host connectivity in the presence of an OSPF LSA falsification attack.

Between 1974 and 1984 the Zickel supracondylar nail system was used to fix 82 femora. Sixty-nine femora had supracondylar fractures and 13 supracondylar osteotomies. A high rate of union (98%) was achieved in the fracture group, which included a variety of fracture types, but five supracondylar osteotomies failed to unite initially and required additional surgery. Knee motion exceeded 90 degrees in 70% of the femora that healed but was poorest in the T or Y intracondylar fracture group, in which only 46% exceeded 90 degrees. The operation may be performed as either open or closed nailing. Closed nailing, when possible, is the procedure of choice because of the decreased postoperative morbidity and increased knee motion. Two-thirds of this series were patients older than 60 years, and the device seems particularly helpful in aged individuals.