Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Bi-level Programming Formulation and Heuristic Solution Approach for Dynamic Traffic Signal Optimization

Dazhi Sun
Conventional methods of signal timing optimization assume given traffic flow pattern, whereas traffic assignment is performed with the assumption of fixed signal timing. This study develops a bi-level programming formulation and heuristic solution approach (HSA) for dynamic traffic signal optimization in networks with time-dependent demand and stochastic route choice. In the bi-level programming model, the upper level problem represents the decision-making behavior (signal control) of the system manager, while the user travel behavior is represented at the lower level. The HSA consists of a Genetic Algorithm (GA) and a Cell Transmission Simulation (CTS) based Incremental Logit Assignment (ILA) procedure. GA is used to seek the upper level signal control variables. ILA is developed to find user optimal flow pattern at the lower level, and CTS is implemented to propagate traffic and collect real-time traffic information. The performance of the HSA is investigated in numerical applications in a sample network. These applications compare the efficiency and quality of the global optima achieved by Elitist GA and Micro GA. Furthermore, the impact of different frequencies of updating information and different population sizes of GA on system performance is analyzed. [source]

The death of cardiotonic steroid-treated cells: evidence of Na+i,K+i -independent H+i -sensitive signalling

S. N. Orlov
Abstract Na/K-ATPase is the only known target of cardiotonic steroids (CTS) identified in plants, amphibians and later on in several mammalian species, including human. We focus our review on recent data implicating CTS in the tissue-specific regulation of cell survival and death. In vascular smooth muscle cells, CTS inhibited cell death triggered by apoptotic stimuli via a novel Na+i -mediated, Ca2+i -independent mechanism of expression of antiapoptotic genes, including mortalin. In contrast, exposure to CTS in vascular endothelial and renal epithelial cells led to cell death, showing combined markers of apoptosis and necrosis. This mode of cell death, termed oncosis, is caused by CTS interaction with Na/K-ATPase but is independent of the inhibition of Na/K-ATPase-mediated ion fluxes and inversion of the [Na+]i/[K+]i ratio. The intermediates of intracellular signalling involved in Na+i, K+i -independent oncosis of CTS-treated cells remain unknown. Recently, we found that this mode of cell death can be protected by modest intracellular acidification via the expression of H+i -sensitive genes. The molecular origin of intracellular Na+ and H+ sensor involvement in the development of apoptosis and oncosis is currently under investigation. [source]

Ca2+ -dependent in vitro contractility of a precipitate isolated from an extract of the heliozoon Actinophrys sol

CYTOSKELETON, Issue 2 2006
Mikihiko Arikawa
Abstract Contraction of axopodia in actinophrid heliozoons (protozoa) is induced by a unique contractile structure, the "contractile tubules structure (CTS)". We have previously shown that a cell homogenate of the heliozoon Actinophrys sol yields a precipitate on addition of Ca2+ that is mainly composed of filamentous structures morphologically identical to the CTS. In this study, to further characterize the nature of the CTS in vitro, biochemical and physiological properties of the precipitate were examined. SDS-PAGE analysis showed that the Ca2+ -induced precipitate was composed of many proteins, and that no proteins in the precipitate showed any detectable changes in electrophoretic mobility on addition of Ca2+. Addition of extraneous proteins such as bovine serum albumin to the cell homogenate resulted in cosedimentation of the proteins with the Ca2+ -induced precipitate, suggesting that the CTS has a high affinity for other proteins that are not related to precipitate formation. Appearance and disappearance of the precipitate were repeatedly induced by alternating addition of Ca2+ and EGTA, and its protein composition remained unchanged even after repeated cycles. When adhered to a glass surface, the precipitate showed Ca2+ -dependent contractility with a threshold of 10,100 nM, and this contractility was not inhibited by colchicine or cytochalasin B. The precipitate repeatedly contracted and relaxed with successive addition and removal of Ca2+, indicating that the contraction was controlled by Ca2+ alone with no need for any other energy supply. From our characterization of the precipitate, we concluded that its Ca2+ -dependent formation and contraction are associated with the unique contractile organelle, the "contractile tubules structure". Cell Motil. Cytoskeleton 2006. © 2005 Wiley-Liss, Inc. [source]

Autosomal Dominant Inheritance of Centrotemporal Sharp Waves in Rolandic Epilepsy Families

EPILEPSIA, Issue 12 2007
Bhavna Bali
Summary Purpose: Centrotemporal sharp (CTS) waves, the electroencephalogram (EEG) hallmark of rolandic epilepsy, are found in approximately 4% of the childhood population. The inheritance of CTS is presumed autosomal dominant but this is controversial. Previous studies have varied considerably in methodology, especially in the control of bias and confounding. We aimed to test the hypothesis of autosomal dominant inheritance of CTS in a well-designed family segregation analysis study. Methods: Probands with rolandic epilepsy were collected through unambiguous single ascertainment. Siblings in the age range 4,16 years underwent sleep-deprived EEG; observations from those who remained awake were omitted. CTS were rated as present or absent by two independent observers blinded to the study hypothesis and subject identities. We computed the segregation ratio of CTS, corrected for ascertainment. We tested the segregation ratio estimate for consistency with dominant and recessive modes of inheritance, and compared the observed sex ratio of those affected with CTS for consistency with sex linkage. Results: Thirty siblings from 23 families underwent EEG examination. Twenty-three showed evidence of sleep in their EEG recordings. Eleven of 23 recordings demonstrated CTS, yielding a corrected segregation ratio of 0.48 (95% CI: 0.27,0.69). The male to female ratio of CTS affectedness was approximately equal. Conclusions: The segregation ratio of CTS in rolandic epilepsy families is consistent with a highly penetrant autosomal dominant inheritance, with equal sex ratio. Autosomal recessive and X-linked inheritance are rejected. The CTS locus might act in combination with one or more loci to produce the phenotype of rolandic epilepsy. [source]

Comparison of three conservative treatment protocols in carpal tunnel syndrome

O. Baysal
Summary The aim of this study was to investigate and compare the therapeutic effect of three different combinations in the conservative treatment of carpal tunnel syndrome (CTS) by means of clinical and electrophysiological studies. The combinations included tendon- and nerve-gliding exercises in combination with splinting, ultrasound treatment in combination with splinting and the combination of ultrasound, splinting, tendon- and nerve-gliding exercises. A total 28 female patients (56 wrists) with clinical and electrophysiologic evidence of bilateral CTS were studied. In all patient groups, the treatment combinations were significantly effective immediately and 8 weeks after the treatment. The results of the long-term patient satisfaction questionnaire revealed that symptomatic improvement is more prominent in the group treated with splinting, exercise and ultrasound therapy combination. Our results suggest that a combination of splinting, exercise and ultrasound therapy is a preferable and an efficacious conservative type of treatment in CTS. [source]

Dementia Care Mapping reconsidered: exploring the reliability and validity of the observational tool

A. Thornton
Abstract Background Dementia Care Mapping (DCM) is a widely used observational method for evaluating the service quality provided to people with dementia. However, there is little evidence concerning its reliability and validity when used by routine care staff for whom it was designed. Method The study evaluated levels of inter-observer agreement; The ability of the five-minute time frame to reflect the ,actual passing of time'; And the nature of the relationship between individual Well/Ill-Being values (WIB) and dependency levels. Data collected using DCM and continuous time sampling (CTS) were compared. The methods were used in parallel where the CTS coder and the DCM mapper(s) observed the same participants. Observations were carried out with 64 people with dementia within a day hospital and a continuing care ward. Inter-observer agreement was calculated across 20 participants. Dependency levels were measured using the Clifton Assessment Procedure for the Elderly (CAPE) (Pattie and Gilleard, 1979). Results Low levels of inter-observer agreement were found where 11 of the 25 Behaviour Category codes and all six Well/Ill-being Codes produced unacceptable kappas (<0.6). The Behaviour coding frame provided a meaningful picture of activities participants engaged in, but significantly underestimated participant levels of inactivity. A strong relationship was demonstrated between participants' WIB score and levels of dependency, thus DCM was unable to measure well-/ill-being as a separate construct from participants' levels of dependency. Conclusions Questions were raised regarding the reliability and validity of DCM as used by routine care staff. Possible reasons for this, and suggestions for amendments are made. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome

D. Pastare MD
Abstract Purpose. To compare the diagnostic value of high-resolution ultrasound (US) with nerve conduction studies (NCS) in patients with clinically defined carpal tunnel syndrome (CTS). Methods. A prospective study was conducted on 66 consecutive patients investigated for sensory hand symptoms. The gold standard was the clinical diagnosis of CTS. Results. NCS showed greater diagnostic sensitivity (82%) than US (62%) in supporting a diagnosis of CTS. With increasing neurophysiologic severity of median neuropathy, there was increasing convergence of the two test methods. Abnormal US as the only diagnostic supportive evidence of CTS was rare. However, the positive predictive value of US for CTS was 100%. Conclusion. NCS show better sensitivity than US in supporting a diagnosis of CTS. However, because of its high positive predictive value, one may consider using US as a screening test, eliminating the need for NCS in the majority of clinical suspicion of CTS and reserving NCS for cases in which US is negative. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009 [source]

Classroom Discussions with Student-Led Feedback: a Useful Activity to Enhance Development of Critical Thinking Skills

Kirby D. Hayes
ABSTRACT:, Critical thinking skills (CTS) are the core learning outcome measures for higher education. Generally, CTS are not extensively developed or practiced during primary and secondary education. As such, early cultivation of CTS is essential for mastery prior to collegiate matriculation. Weekly engagement in 50 min of classroom discussion with student feedback (CDSF) was utilized to develop the CTS of students in an introductory food science course at Purdue Univ. Students' critical thinking ability was assessed longitudinally over a 16-wk semester using the ACT-CAAPÔ (Collegiate Assessment of Academic Proficiency) critical thinking test. The ACT-CAAP measures the students' ability to analyze, evaluate, and extend an argument described in a short passage. We hypothesized that the implementation of CDSF for 16 wk would expedite development of CTS for students enrolled in the course. The CDSF intervention significantly increased critical thinking ability for non-native English speaking students as compared to native English speaking students. Students who were classified as sophomore status or above when compared to freshmen and students enrolled as food science majors when compared to other majors also demonstrated increased critical thinking ability. Recitation size also significantly influenced critical thinking ability where students enrolled in a relatively small recitation section had elevated critical thinking when compared to the abilities of those students enrolled in a large recitation. These observations suggest that engaging students in classroom discussions with student-led feedback is a useful instructional technique for developing CTS. Further, the data suggest the development of critical thinking skill among food science majors can be augmented when classroom discussions with student-led feedback are conducted in smaller sized recitations. [source]

Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome

Michel W. Coppieters
Abstract Nerve and tendon gliding exercises are advocated in the conservative and postoperative management of carpal tunnel syndrome (CTS). However, traditionally advocated exercises elongate the nerve bedding substantially, which may induce a potentially deleterious strain in the median nerve with the risk of symptom exacerbation in some patients and reduced benefits from nerve gliding. This study aimed to evaluate various nerve gliding exercises, including novel techniques that aim to slide the nerve through the carpal tunnel while minimizing strain ("sliding techniques"). With these sliding techniques, it is assumed that an increase in nerve strain due to nerve bed elongation at one joint (e.g., wrist extension) is simultaneously counterbalanced by a decrease in nerve bed length at an adjacent joint (e.g., elbow flexion). Excursion and strain in the median nerve at the wrist were measured with a digital calliper and miniature strain gauge in six human cadavers during six mobilization techniques. The sliding technique resulted in an excursion of 12.4 mm, which was 30% larger than any other technique (p,,,0.0002). Strain also differed between techniques (p,,,0.00001), with minimal peak values for the sliding technique. Nerve gliding associated with wrist movements can be considerably increased and nerve strain substantially reduced by simultaneously moving neighboring joints. These novel nerve sliding techniques are biologically plausible exercises for CTS that deserve further clinical evaluation. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:972,980, 2007 [source]

Risks of allogeneic hand transplantation

MICROSURGERY, Issue 2 2004
Steffen Baumeister M.D.
A patient undergoing allogeneic hand transplantation needs lifelong immunosuppression with the risk of serious side effects, including life-threatening disease. The question remains: does the eventual improvement in function justify the risk? To answer this question, we try to assess the risks based on a large body of cumulative data derived from more 200,000 kidney transplants using the Collaborative Transplantation Study (CTS). Only selective data which apply to a patient population aged between 15,40 years were used (n = 58,310). Data are compared to the literature references and show superiority with respect to patient numbers, statistics, actuality, and methodology. The CTS data show that the incidence of de novo malignancies is lower than previously reported. The risk of developing any form of cancer is approximately 3%, of developing a skin cancer 1.1%, and of developing a lymphoma 0.58% within 5 years after transplantation. The risk of suffering from a cataract is 11% after 5 years, which is also lower than previously reported. Although the incidence of side effects (particularly malignant disease) is likely to be lower than previously thought, the risk-benefit question must be answered by each hand surgeon for each individual patient. © 2004 Wiley-Liss, Inc. [source]

Simplified orthodromic inching test in mild carpal tunnel syndrome

MUSCLE AND NERVE, Issue 12 2001
Paul Seror MD
Abstract This prospective study was undertaken to determine the clinical relevance, reliability, sensitivity, and specificity of the orthodromic inching test with 2-cm incremental study of the median nerve over the four intracarpal centimeters in 50 control and 50 successive (unselected) patient wrists with mild carpal tunnel syndrome (CTS). In controls, the mean maximum conduction delay per 2 cm (CD/2cm) was 0.445 ± 0.04 ms, and abnormality was defined as at least one CD/2cm exceeding the mean + 2.5 SD of the normal CD/2cm. This yielded a specificity of 98%. In patients with mild unselected CTS, this simplified orthodromic inching test (SOIT) detected the median nerve lesion at the wrist in 47 cases (sensitivity = 94%). The SOIT detected 15 more CTS cases than did the orthodromic median-ulnar latency difference of the 4th digit (Chi square = 13; P = .002). Thus, the SOIT was as effective as an incremental study every centimeter over 10 cm, and the time required for the test allows its routine use when other electrodiagnostic tests fail to reveal any median nerve impairment. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 1595,1600, 2001 [source]

When to use the combined sensory index,

MUSCLE AND NERVE, Issue 8 2001
Matthew P. Kaul MD
Abstract A recently developed electrodiagnostic technique, the combined sensory index (CSI), has been recommended for its greater sensitivity in diagnosing carpal tunnel syndrome (CTS). The CSI requires a greater number of procedures and therefore involves greater time, cost, and patient discomfort than does conventional electrodiagnostic testing. The CSI is composed of three commonly used electrodiagnostic techniques. There is a close correlation between the components of the CSI, and in most cases, all three components of the CSI are in agreement. We performed a study to develop and validate an algorithm that could be used to identify subsets of patients with CTS in whom CSI testing is particularly useful. Subjects were consecutive outpatient veterans referred by a heterogeneous group of specialists and generalists for electrodiagnostic evaluation of paresthesias in a median distribution with nocturnal exacerbation of symptoms. The CSI served as our gold standard. Using our simple algorithm, we found that in approximately 95% of cases, it was unnecessary to perform the CSI. This management strategy improves patient comfort and reduces electrodiagnostic cost while identifying the minority of patients for whom the CSI is indicated. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 1078,1082, 2001 [source]

The de Quervain's screening tool: Validity and reliability of a measure to support clinical diagnosis and management

DipCOT, Rachel Batteson PhD
Abstract Background:,Studies into the effectiveness of interventions for upper limb soft tissue disorders have been hampered by a lack of consistently used diagnostic criteria, meaning that comparison of research results is a problem. To aid homogeneous recruitment into a study of de Quervain's disease, a de Quervain's screening tool (DQST) was developed. This could also be used to facilitate clinical diagnosis and management in practice. Aims:,To provide evidence for the content and construct validity and test,retest and inter-rater reliability of the DQST. Method:,The study was conducted in an acute care, outpatient hand unit in a district general hospital. Three convenience samples of: 59 people with de Quervain's disease; 18 with carpal tunnel syndrome (CTS) and 16 with osteoarthritis (OA) of the carpometacarpal (CMC) joint were recruited. The DQST diagnostic criteria were initially generated from a literature review. Content validity was then established by expert doctors with an interest in upper limb musculoskeletal disorders (n = 7) rating the relevance of the seven items included. The DQST was then tested in people either already diagnosed with, or reported as having some of the symptoms of, de Quervain's disease. Construct validity was tested with people with CTS or OA of the CMC joint. Results:,The median DQST score was 5 (Interquartile range IQR = 4,6) out of a possible seven diagnostic criteria. Inter-rater reliability was excellent (Intra-class coefficient [ICC] = 0.85; 95% confidence interval [CI] = 0.75, 0.91). Test retest reliability was good (ICC = 0.64; 95% CI = 0.20, 0.87). Sensitivity (Se) and specificity (Sp) testing (Se = 1.00; Sp = 1.00) demonstrated that the DQST discriminated between people with de Quervain's disease, CTS or OA of the CMC joint. Conclusions:,The DQST is a valid, reliable tool which could be of assistance in aiding correct diagnosis for recruitment to clinical trials and in clinical practice. Future research is recommended to further examine retest reliability with a larger sample size and to identify the commonest diagnostic criteria required for inclusion. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Pyridoxine Hydrochloride Treatment of Carpal Tunnel Syndrome: A Review

Elaine Aufiero M.D.
It has been hypothesized that idiopathic carpal tunnel syndrome (CTS) is a manifestation of vitamin B6 deficiency. Some claim that B6 supplementation can alleviate symptoms. Others argue that pain relief occurs because of vitamin B6's anti-nociceptive properties or because B6 supplementation addresses an unrecognized peripheral neuropathy. Few studies on CTS and B6 employed electrodiagnostic techniques in diagnosis, and few showed a correlation between symptoms and improved electrodiagnostic parameters with supplementation. Other studies failed to measure or estimate B6 levels. Nevertheless, it appears reasonable to recommend vitamin B6 supplementation to people with CTS. Some patients will improve symptomatically with low risks of toxicity in recommended doses. [source]

Work-related carpal tunnel syndrome in Washington State workers' compensation: Utilization of surgery and the duration of lost work

William E. Daniell MD
Abstract Background Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability. Methods This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n,=,8,224) filed during 1990,1994 (followed through 2000) and receiving lost-work compensation. Results Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P,<,0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery. Conclusions There is a need to scrutinize the role of surgery and physical-rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post-operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution. Am. J. Ind. Med. 52:931,942, 2009. © 2009 Wiley-Liss, Inc. [source]

Variations in diagnostic criteria for carpal tunnel syndrome among Ontario specialists,

Brent Graham MD, FRCSC
Abstract Background Variations in diagnostic criteria for carpal tunnel syndrome (CTS) may result in differing reports of disease prevalence, errors in diagnosis, and variable results of treatment. The objective of this study was to determine how consistent specialists are in their ratings of the importance of clinical criteria for the diagnosis of CTS. Methods Three hundred specialist physicians and surgeons received a questionnaire containing 57 clinical criteria for the diagnosis of CTS. A visual analog scale (VAS) was used to rate the importance of each criterion in the diagnosis of CTS. Results The overall consistency both across and within specialties was poor (intraclass correlation coefficient across specialties (ICC),=,0.28; ICC range within specialties 0.27,0.37). Conclusions Specialists are relatively inconsistent in the importance they assign to clinical criteria for the diagnosis of CTS. This inconsistency may be an important source of variation in the reported prevalence and treatment of CTS. Am. J. Ind. Med. 49:8,13, 2006. © 2005 Wiley-Liss, Inc. [source]

Work-related carpal tunnel syndrome in Washington State workers' compensation: Temporal trends, clinical practices, and disability

William E. Daniell MD
Abstract Background Work-related carpal tunnel syndrome (CTS) is a leading cause of disability. There is a need for information about temporal trends, clinical practices, and treatment outcomes. Methods A population based, retrospective cohort study of Washington State workers' compensation claims for CTS was initiated focusing on claims filed during 1990,1994, followed through 2000 (n,=,16,710). Results Half of the claims were filed for conditions other than CTS, but were eventually identified to be or include CTS. The first CTS diagnosis occurred more than 3 months after claim filing in 20% of claims. The longer that the CTS diagnosis occurred after claim filing, the more likely that CTS was accompanied by other problems, and disability tended to be longer. Conclusions Making an accurate diagnosis of CTS and initiating appropriate actions earlier than might otherwise occur could reduce the disability and costs in a large fraction of claims that are ultimately determined to involve CTS. © 2005 Wiley-Liss, Inc. [source]

Work-related carpal tunnel syndrome (WR-CTS) in Massachusetts, 1992,1997: Source of WR-CTS, outcomes, and employer intervention practices,

Helen Wellman MS
Abstract Background The Massachusetts Sentinel Event Notification System for Occupational Risks (MASS SENSOR) receives reports of work-related carpal tunnel syndrome (WR-CTS) cases from (1) workers' compensation (WC) disability claims for 5 or more lost work days; and (2) physician reports (PR). Methods From 1992 through 1997, 1,330 WC cases and 571 PR cases completed follow-back surveys to provide information on industry, occupation, attributed source of WR-CTS, outcomes, and employer intervention practices. Results Sixty-four percent of the respondents had bilateral CTS and 61% had surgery, both of which were proportionally more frequent among WC cases. Office and business machinery was the leading source of WR-CTS (42% of classifiable sources) in every economic sector except construction, followed by hand tools (20%). Managers and professional specialty workers were the most likely to report employers' interventions and were up to four times more likely to report equipment or work environment changes than higher risk groups. Conclusions State-based surveillance data on the source of WR-CTS provided valuable information on how and where to implement interventions. New occurrences of WR-CTS are likely, especially in the highest risk industries where very few cases reported primary prevention measures (e.g., changes to equipment or work environment) implemented by their employers. Am. J. Ind. Med. 45:139,152, 2004. © 2004 Wiley-Liss, Inc. [source]

Carpal tunnel syndrome among apprentice construction workers,

John C. Rosecrance PT
Abstract Background In terms of lost-work time and restricted workdays, surgery, and rehabilitation, one of the most costly occupational musculoskeletal disorders is carpal tunnel syndrome (CTS). The purpose of this study was to determine the prevalence of CTS among apprentice construction workers. Methods This cross-sectional study included apprentices from four construction trades. Apprentices completed a self-administered questionnaire and received electrophysiologic studies assessing median nerve function across the carpal tunnel. A surveillance case definition for CTS was based on characteristic hand symptoms and the presence of median mononeuropathy across the carpal tunnel. Results Of the 1,325 eligible apprentices, 1,142 (86.2%) participated in the study. The prevalence of CTS among apprentices was 8.2%; sheet metal workers had the highest rate (9.2%). In operating engineers, the prevalence of CTS was significantly higher (OR,=,6.9; 95% CI,=,2.6,18.2) among the heavy equipment mechanics than the drivers of those vehicles. Body mass index, age, and self-reports of working overhead were associated with prevalent CTS. Less than 15% of the apprentices with CTS sought medical attention for their disorder. Conclusions Many construction workers begin developing CTS before or during their apprenticeship. Few apprentices seek medical attention for hand symptoms characteristic of CTS. The results of this study indicate a public health need for the implementation of prevention strategies for CTS in the construction industry. Am. J. Ind. Med. 42:107,116, 2002. © 2002 Wiley-Liss, Inc. [source]

Osmotic adjustment of chickpea (Cicer arietinum) is not associated with changes in carbohydrate composition or leaf gas exchange under drought

P.S. Basu
Abstract Genetic differences in osmotic adjustment (OA) have been reported among chickpea (Cicer arietinum) cultivars. In this study eight advanced breeding lines (ABLs) derived from a cross between CTS 60543 (high OA) and Kaniva (low OA) and Tyson (medium OA) and Kaniva, along with the parents, were evaluated for OA, leaf carbohydrate composition and leaf gas exchange under dryland field conditions in India. The water potential (WP) decreased to lower values (less than ,2.5 MPa) in Tyson, M 110 and M 86 than in the other genotypes. With decrease in WP, OA increased by 0.5 MPa in Kaniva and CTS 60543 to 1.3 MPa in M 55. As the decrease in WP varied with genotype, when OA was regressed against WP M 39 and M 55 had greater increases in OA with decrease in WP than the remaining nine genotypes, including the parents. As WP decreased, leaf starch content decreased while total soluble sugars, hexoses and sucrose increased: the decrease in starch was much smaller in M 93 and M 129 than in Tyson and M 51, but genotypic differences could not be detected in the increase in total sugars, hexoses or sucrose. The rates of photosynthesis and transpiration decreased as the WP became more negative, but M 129 reached low rates of photosynthesis (2 ,mol m,2 s,1) and transpiration at a WP of ,1.7 MPa, whereas Tyson reached the same low rate at ,2.4 MPa. While OA varied among the chickpea genotypes, the differences were not associated with the changes in carbohydrate composition or the rates of gas exchange at low values of WP. Further, the degree of OA of the 11 genotypes was not the same as when they were selected for differences in OA under rainout shelter conditions in the field in Australia, suggesting that OA may show poor stability depending upon the stress level, location or physiological stage of the plant. This suggests that OA is not a valuable drought-resistance trait to select for in chickpea breeding programmes. [source]

When exactly can carpal tunnel syndrome be considered work-related?

Sonja Falkiner
Background: Carpal tunnel syndrome (CTS), compression of the median nerve at the wrist, is the most frequently encountered peripheral entrapment neuropathy. Whilst rates of all other work-related conditions have declined, the number of work-related musculoskeletal disorders (which include CTS) has not changed for the past 9 years in the USA. Median days off work are also highest for CTS: 27 compared to 20 for fractures and 18 for amputations. This results in enormous Workers Compensation and other costs to the community. Awareness of CTS as a disorder associated with repeated trauma at work is now so widespread amongst workers that many have diagnosed themselves before being medically assessed, often by means of the Internet. Surprisingly, however, a definite causal relationship has not yet been established for most occupations. Although the quality of research in this area is generally poor, CTS research studies are being used as the basis for acceptance of Workers Compensation claims, substantial expensive ergonomic workplace change and even workplace closures. The fact that the incidence of work-related musculoskeletal disorders has not changed despite these latter measures would suggest that a causal relationship is not proven and that some resources are being misdirected in CTS prevention and treatment. Method: A literature review of 64 articles on CTS was conducted. This included those articles most frequently cited as demonstrating the relationship between CTS and work. Results: Primary risk factors in the development of CTS are: being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake. In most cases, work acts as the ,last straw' in CTS causation. Conclusion: Except in the case of work that involves very cold temperatures (possibly in conjunction with load and repetition) such as butchery, work is less likely than demographic and disease-related variables to cause CTS. To label other types of work as having caused CTS, therefore, would result in inappropriate allocation of resources. It would also relieve individuals of the responsibility of addressing correctable lifestyle factors and treatable illnesses such as obesity, diabetes, smoking and increased alcohol intake which may have contributed to their CTS more that their work. This results in both avoidable long-term health effects and ongoing costs to the community. [source]

The significance of second lumbrical-interosseous latency comparison in the diagnosis of carpal tunnel syndrome

A. A. Argyriou
Aim,,, To assess the significance of the second lumbrical-interosseous latency (2LI-DML) comparison in the diagnosis of carpal tunnel syndrome (CTS). Patients and methods,,, We examined 150 consecutive hands of patients referred with suspected CTS, using the 2LI-DML test and other standard measures of median nerve function. Correlations of the 2LI-DML test with standard tests were computed. Results,,, Hundred and four hands were electrophysiologically confirmed to have CTS. The 2LI-DML test was abnormal in 99/104 (95.2%) hands with CTS with a mean value of 1.54 ± 1.12 ms. Among the other measures, the orthodromic median,ulnar palmar velocity comparison was the most frequently abnormal test (95/104 hands, 91.3%), followed by the double-peak morphology of orthodromic sensory action potential from digit 4 (94/104, 90.4%). The 2LI-DML test significantly correlated, either positively or negatively, with all other standard tests. Conclusion,,, The 2LI-DML comparison is highly sensitive in diagnosing CTS, even in mild cases in which standard tests fail to detect abnormalities. [source]

Efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome: a randomized controlled study

M. V. De Angelis
Objective,,, To examine, in a randomized, controlled, single blinded trial, the efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome (CTS). Methods,,, We randomized 120 patients with CTS into a group wearing the soft hand brace MANU® and into another group wearing the wrist splint CAMP TIELLE® at night for 3 months. We re-evaluated the patients after 3 (T1) and 9 months (T2). The primary efficacy measures were changes in scores of Boston Carpal Tunnel Questionnaire (BCTQ) and in Visual Analogical Scale (VAS) for pain and paresthesias. Results,,, At T1, both groups showed a significant reduction in symptomatic and functional BCTQ (T0,T1 differences: MANU® BCTQ sympt: 0.88 (0.68,1.08), funct: 0.45 (0.19,0.72); TIELLE® BCTQ sympt: 0.78 (0.55,1.01), funct: 0.41 (0.22,0.59). At T2, a less evident benefit on symptoms persisted in both groups, except for pain VAS score that was significantly reduced only in the CAMP TIELLE® group. No significant functional benefits persisted in either group. There were no differences in BCTQ and VAS scores between the two groups at T1 and T2 compared with that at baseline. Conclusions,,, A 3-month treatment with either the hand brace or the wrist splint induces a symptomatic and functional benefit in patients with CTS. [source]

Transverse carpal muscle in association with carpal tunnel syndrome: Report of three cases

Dogan Tuncali
Abstract Anomalous muscles of the upper extremity are common, however, symptomatic anomalies causing CTS are rare. Three cases of CTS that are believed to be caused by an anomalous muscle located palmar to the transverse carpal ligament with transversely oriented muscle bundles is presented. Despite the arguments in literature, this is certainly an anomalous muscle that can be encountered during carpal tunnel release and be problematic to manipulate when minimally invasive approaches are chosen. Clin. Anat. 18:308,312, 2005. © 2005 Wiley-Liss, Inc. [source]

The Risk of Intra-abdominal Injuries in Pediatric Patients with Stable Blunt Abdominal Trauma and Negative Abdominal Computed Tomography

Jeffrey Hom MD
Abstract Objectives:, This review examines the prevalence of intra-abdominal injuries (IAI) and the negative predictive value (NPV) of an abdominal computed tomography (CT) in children who present with blunt abdominal trauma. Methods:, MEDLINE, EMBASE, and Cochrane Library databases were searched. Studies were selected if they enrolled children with blunt abdominal trauma from the emergency department (ED) with significant mechanism of injury requiring an abdominal CT. The primary outcome measure was the rate of IAI in patients with negative initial abdominal CT. The secondary outcome measure was the number of laparotomies, angiographic embolizations, or repeat abdominal CTs in those with negative initial abdominal CTs. Results:, Three studies met the inclusion criteria, comprising a total of 2,596 patients. The overall rate of IAI after a negative abdominal CT was 0.19% (95% confidence interval [CI] = 0.08% to 0.44%). The overall NPV of abdominal CT was 99.8% (95% CI = 99.6% to 99.9%). There were five patients (0.19%, 95% CI = 0.08% to 0.45%) who required additional intervention despite their initial negative CTs: one therapeutic laparotomy for bowel rupture, one diagnostic laparotomy for mesenteric hematoma and serosal tear, and three repeat abdominal CTs (one splenic and two renal injuries). None of the patients in the latter group required surgery or blood transfusion. Conclusions:, The rate of IAI after blunt abdominal trauma with negative CT in children is low. Abdominal CT has a high NPV. The review shows that it might be safe to discharge a stable child home after a negative abdominal CT. ACADEMIC EMERGENCY MEDICINE 2010; 17:469,475 © 2010 by the Society for Academic Emergency Medicine [source]

Pap test discrepancies and follow-up histology

Who's right, does it help to know?
Abstract Papanicolaou (Pap) test discrepancy rates between cytotechnologists (CTs) and cytopathologists (CPs) are often kept to evaluate the performance of individual CTs. This is based on the unproven assumption that the CP's diagnoses are more likely to be correct. We investigated this assumption using data from our discrepancy files and comparing them to follow-up histology. All Pap test discrepancies were noted between January 1, 2001,December 31, 2001. Surgical pathology files were then searched for follow-up histology within 9 mo of the Pap test. Histologic diagnoses were compared with the previous CT and CP diagnoses, and then judged regarding accuracy. In total, 63,376 Pap tests were evaluated between January 1, 2001,December 31, 2001. There were 795 discrepancies throughout this period (1.25%). One hundred and sixty-six cases with discrepancies had follow-up histology within 9 mo of the Pap test (20.9%). Of downgraded cases (103), CPs were more correct in 51 cases (49.5%), whereas CTs were more correct in 52 cases (50.5%). Of upgraded cases (63), CPs were more correct in 19 cases (30.2%), whereas CTs were more correct in 44 cases (69.8%). Our results suggest that CPs are not more likely to be correct than CTs when there is a discrepancy with the diagnosis of a Pap test, especially when CPs upgrade CT diagnoses. This suggests that discrepancy data may be helpful for evaluating the performance of both CPs and CTs. It may also be of educational use for both CPs and CTs to know the follow-up histology in these cases. Diagn. Cytopathol. 2003;29:111,115. © 2003 Wiley-Liss, Inc. [source]

The use of complementary therapy by men with prostate cancer in the UK

The study aims were to determine the use of complementary therapies (CT) by men with prostate cancer, and to explore factors influencing CT use and attitudes toward CT use. A cross-sectional survey design was used in which a postal questionnaire was mailed to an eligible sample of 405 patients with prostate cancer receiving outpatient treatment in a London teaching hospital. The primary outcomes were the prevalence of CT use and the relationship between CT use and mental health status. Two hundred and ninety-four patients (73%) responded, of whom 25% were using CT. The most frequently used CTs were vitamins, low-fat diets, lycopene and green tea. Multivariate analyses revealed no differences in mental health scores between CT users and non-users. CT users were younger (OR 0.93, 95% CI 0.89,0.97) and were more likely to be receiving conservative management in the form of ,active surveillance' (OR 5.23, 95% CI 1.78,15.41) compared with non-users. Over half of the participants (55%) wanted to learn more about CT. Forty-three per cent of CT users had not informed any doctor about their CT use. Clinicians need to be aware of the prevalence of CT use amongst patients with prostate cancer, considering the potential harm that could be caused by interactions with conventional treatments. [source]

Prevalence of Herniation and Intracranial Shift on Cranial Tomography in Patients With Subarachnoid Hemorrhage and a Normal Neurologic Examination

Larry J. Baraff MD
Abstract Objectives:, Patients frequently present to the emergency department (ED) with headache. Those with sudden severe headache are often evaluated for spontaneous subarachnoid hemorrhage (SAH) with noncontrast cranial computed tomography (CT) followed by lumbar puncture (LP). The authors postulated that in patients without neurologic symptoms or signs, physicians could forgo noncontrast cranial CT and proceed directly to LP. The authors sought to define the safety of this option by having senior neuroradiologists rereview all cranial CTs in a group of such patients for evidence of brain herniation or midline shift. Methods:, This was a retrospective study that included all patients with a normal neurologic examination and nontraumatic SAH diagnosed by CT presenting to a tertiary care medical center from August 1, 2001, to December 31, 2004. Two neuroradiologists, blinded to clinical information and outcomes, rereviewed the initial ED head CT for evidence of herniation or midline shift. Results:, Of the 172 patients who presented to the ED with spontaneous SAH diagnoses by cranial CT, 78 had normal neurologic examinations. Of these, 73 had initial ED CTs available for review. Four of the 73 (5%; 95% confidence interval [CI] = 2% to 13%) had evidence of brain herniation or midline shift, including three (4%; 95% CI = 1% to 12%) with herniation. In only one of these patients was herniation or shift noted on the initial radiology report. Conclusions:, Awake and alert patients with a normal neurologic examination and SAH may have brain herniation and/or midline shift. Therefore, cranial CT should be obtained before LP in all patients with suspected SAH. ACADEMIC EMERGENCY MEDICINE 2010; 17:423,428 © 2010 by the Society for Academic Emergency Medicine [source]

Connecting linguistic description and language teaching: native and learner use of existential there1

Ignacio Palacios-Martínez
construcciones existenciales; corpus de estudiantes; enseñanza de lenguas; lingüística contrastiva; lingüística de corpus This article emerges from the need to connect linguistic theory and language teaching to find concrete solutions to problems Spanish students confront when learning English. This study looks at existential there constructions taken from the following native and non-native written English corpora: the International Corpus of Learner English and the Santiago University Learner of English Cor-pus for the non-native set, and the Louvain Corpus of Native English Essays, Biber et al. (1999) and a subcorpus of the BNC for the native English group. This contrastive study reveals important differences in the use of there constructions as regards their frequency, structural complexity, polarity and pragmatic value. Important implications for the presentation and the pedagogical treatment of the there constructions can be derived from the results. El presente artículo surge de la necesidad de conectar la teoría lingüística y la práctica pedagógica, tratando de encontrar soluciones concretas a problemas con los que se enfrentan alumnos españoles de inglés como lengua extranjera. Este trabajo estudia las construcciones existenciales con there (CTs) a partir de los siguientes corpus de textos escritos de hablantes nativos y no nativos: International Corpus of Learner English y Santiago University Learner of English Corpus para los no nativos, y Louvain Corpus of Native English Essays, Biber et al. (1999) y un subcorpus del BNC para los nativos. Este estudio contrastivo constata diferencias importantes en el uso de las CTs relativas a su frecuencia, complejidad estructural, polaridad y valor pragmático. De todos estos resultados se derivan importantes implicaciones para la presentación y tratamiento pedagógico de las CTs. [source]

A systematic review of controlled trials evaluating interventions in adult literacy and numeracy

Carole Torgerson
This paper reports a systematic review of the quasi-experimental literature in the field of adult literacy and numeracy, published between 1980 and 2002. We included 27 controlled trials (CTs) that evaluated strategies and pedagogies designed to increase adult literacy and numeracy: 18 CTs with no effect sizes (incomplete data) and 9 CTs with full data. These nine trials are examined in detail for this paper. Of these nine trials, six evaluated interventions in literacy and three evaluated interventions in literacy and numeracy. Three of the nine trials showed a positive effect for the interventions, five trials showed no difference and one trial showed a positive effect for the control treatment. The quality of the trials was variable, but many of them had some methodological problems. There was no evidence of publication bias in the review. There have been few attempts to expose common adult literacy or numeracy programmes to rigorous evaluation and therefore in terms of policy and practice it is difficult to make any recommendations as to the type of adult education that should be supported. In contrast, however, the review does provide a strong steer for the direction to be taken by educational researchers: because of the present inadequate evidence base rigorously designed randomised controlled trials and quasi-experiments are required as a matter of urgency. [source]