The Veterans Affairs Neuropathy Scale: A Reliable, Remote Polyneuropathy Exam.

Introduction: Polyneuropathy (PN) complaints are common, prompting many referrals for neurologic evaluation. To improve access of PN care in distant community clinics, we developed a telemedicine service (patient-clinician interactions using real-time videoconference technology) for PN. The primary goal of this study was to construct a remote exam for PN that is feasible, reliable, and concordant with in-person assessments for use in our tele-PN clinics. Methods: To construct the VA Neuropathy Scale (VANS), we searched the literature for existing, validated PN assessments. From these assessments, we selected a parsimonious set of exam elements based on literature-reported sensitivity and specificity of PN detection, with modifications as necessary for our teleneurology setting (i.e., a technician examination under the direction of a neurologist). We recruited 28 participants with varying degrees of PN to undergo VANS testing under 5 scenarios. The 5 scenarios differed by mode of VANS grading (in-person vs. telemedicine) and by the in-person examiner type (neurologist vs. technician) in telemedicine scenarios. We analyzed concordance between the VANS and a person's medical chart-derived PN status by modeling the receiver operating characteristic (ROC) curve. We analyzed reliability of the VANS by mixed effects regression and computing the intraclass correlation coefficient (ICC) of scores across the 5 scenarios. Results: The VA Neuropathy Scale (VANS) tests balance, gait, reflexes, foot inspection, vibration, and pinprick. Possible scores range from 0 to 50 (worst). From the ROC curve, a cutoff of >2 points on the VANS sets the sensitivity and specificity of detecting PN at 98 and 91%, respectively. There is a small (1.3 points) but statistically significant difference in VANS scoring between in-person and telemedicine grading scenarios. For telemedicine grading scenarios, there is no difference in VANS scores between neurologist and technician examinations. The ICC is 0.89 across all scenarios. Discussion: The VANS, informed by existing PN instruments, is a promising clinical assessment tool for diagnosing and monitoring the severity of PN in telemedicine settings. This pilot study indicates acceptable concordance and reliability of the VANS with in-person examinations

Unsteady flow of a thixotropic fluid in a slowly varying pipe

We analyse the unsteady axisymmetric flow of a thixotropic or antithixotropic fluid in a slowly varying cylindrical pipe. We derive general perturbation solutions in regimes of small Deborah numbers, in which thixotropic or antithixotropic effects enter as perturbations to generalised Newtonian flow. We present results for the viscous Moore–Mewis–Wagner model and the viscoplastic Houška model, and we use these results to elucidate what can be predicted in general about the behaviour of thixotropic and antithixotropic fluids in lubrication flow. The range of behaviour we identify casts doubt on the efficacy of model reduction approaches that postulate a generic cross-pipe flow structure

Teleneurology clinics for polyneuropathy: a pilot study.

INTRODUCTION:Polyneuropathy (PN) is a common condition with significant morbidity. We developed tele-polyneuropathy (tele-PN) clinics to improve access to neurology and increase guideline-concordant PN care. This article describes the mixed-methods evaluation of pilot tele-PN clinics at three community sites within the Greater Los Angeles VA Healthcare System. METHODS:For the first 25 patients (48 scheduled visits), we recorded the duration of the tele-PN visit and exam; the performance on three guideline-concordant care indicators (PN screening labs, opiate reduction, physical therapy for falls); and patient-satisfaction scores. We elicited comments about the tele-PN clinic from patients and the clinical team. We combined descriptive statistics with qualitative themes to determine the feasibility and acceptability of the tele-PN clinics. RESULTS:The average tele-PN encounter and exam times were 28.5 and 9.1 min, respectively. PN screening lab completion increased from 80 to 100%. Opiate freedom improved from 68 to 88%. Physical therapy for patients with recent falls increased from 58 to 100%. The tele-PN clinic was preferred for follow-up over in-person clinics in 86% of cases. Convenience was paramount to the clinic's success, saving an average of 231 min per patient in round-trip travel. The medical team's caring and collaborative spirit received high praise. While the clinic's efficiency was equal or superior to in-person care, the limited treatment options for PN and the small clinical exam space are areas for improvement. CONCLUSION:In this pilot, we were able to efficiently see and examine patients remotely, promote guideline-concordant PN care, and provide a high-satisfaction encounter

A first look at dust lifting and dust storms near the south pole of Mars with a mesoscale model

Surface wind stresses and dust lifting in the south polar region of Mars are examined with a three-dimensional numerical model. The focus of this study is the middle to late southern spring period when cap-edge dust lifting events are observed. Mesoscale model simulations of high southern latitudes are conducted at three dates within this season (L_s = 225°, 255°, and 310°). Assuming that dust injection is related to the saltation of sand-sized grains or aggregates, the Mars MM5 mesoscale model predicts surface wind stresses of sufficient strength to initiate movement of sand-sized particles (∼100 μm), and hence dust lifting, during all three periods. The availability of dust and/or sand-sized particles is not addressed within this study. Instead, the degree to which the existence of sufficiently strong winds limit dust injection is examined. By eliminating forcing elements from the model, the important dynamical modes generating high wind stresses are isolated. The direct cap-edge thermal contrast (and topographic slopes in some locations) provides the primary drive for high surface wind stresses at the cap edge, while sublimation flow is not found to be particularly important, at these three dates. Simulations in which dust is injected into the lowest model layer when wind stresses exceed a threshold show similar patterns of atmospheric dust to those seen in recent observations. Comparison between these simulations and those without active dust injection shows no signs of consistent positive or negative feedback due to dust clouds on the surface wind stress fields during the late spring season examined here

Use of Online Health Forums by Patients with Chronic Cough: Qualitative Study

Background: Online health discussion forums are used by different patient groups for sharing advice and information. Chronic cough is a common problem, and people with chronic cough use online health forums alongside formal medical therapies. Objective: The objective of this study was to assess how chronic cough sufferers use online health forums, including the treatment advice they share with one another and the possible clinical uses of online forums in chronic cough. Methods: Three open-access health forums were searched for threads related to chronic cough. Identified threads were screened against inclusion and exclusion criteria adapted from the British Thoracic Society (BTS) Guidelines related to chronic cough diagnosis. Included data were subjected to qualitative thematic analysis. All study data were cross-validated by a second author and discrepancies were resolved. Results: In total, 96 threads were included in the analysis, consisting of posts by 223 forum users. Three main themes were identified: the effect of chronic cough on the lives of patients, the treatment advice shared between users, and the provision of support within forums. Conclusions: Chronic cough symptoms had impacts on multiple aspects of patients’ health and well-being. To try and combat these issues, forum users suggested a variety of treatments to one another, ranging from mainstream traditional therapies to odd alternative remedies. The provision of support and empathy were also prominent themes in discussion threads. Online forums themselves may provide increasing benefit to users through the addition of a moderator

The Murmur of the Sleeping Black Hole: Detection of Nuclear Ultraviolet Variability in LINER Galaxies

LINER nuclei, which are present in many nearby galactic bulges, may be the manifestation of low-rate or low-radiative-efficiency accretion onto supermassive central black holes. However, it has been unclear whether the compact UV nuclear sources present in many LINERs are clusters of massive stars, rather than being directly related to the accretion process. We have used HST to monitor the UV variability of a sample of 17 galaxies with LINER nuclei and compact nuclear UV sources. Fifteen of the 17 galaxies were observed more than once, with two to five epochs per galaxy, spanning up to a year. We detect significant variability in most of the sample, with peak-to-peak amplitudes from a few percent to 50%. In most cases, correlated variations are seen in two independent bands (F250W and F330W). Comparison to previous UV measurements indicates, for many objects, long-term variations by factors of a few over decade timescales. Variability is detected in LINERs with and without detected compact radio cores, in LINERs that have broad H-alpha wings detected in their optical spectra (``LINER 1's''), and in those that do not (``LINER 2s''). This variability demonstrates the existence of a non-stellar component in the UV continuum of all types, and sets a lower limit to the luminosity of this component. We note a trend in the UV color (F250W/F330W) with spectral type - LINER 1s tend to be bluer than LINER 2s. This trend may indicate a link between the shape of the nonstellar continuum and the presence or the visibility of a broad-line region. In one target, the post-starburst galaxy NGC 4736, we detect variability in a previously noted UV source that is offset by 2.5" (60 pc in projection) from the nucleus. This may be the nearest example of a binary active nucleus, and of the process leading to black hole merging.Comment: accepted to Ap

The Nuclear Ionized Gas in the Radio Galaxy M84 (NGC 4374)

We present optical images of the nucleus of the nearby radio galaxy M84 (NGC 4374 = 3C272.1) obtained with the Wide Field/Planetary Camera 2 (WFPC2) aboard the Hubble Space Telescope (HST). Our three images cover the H$\alpha$ + [N II] emission lines as well as the V and I continuum bands. Analysis of these images confirms that the H$\alpha$ + [N II] emission in the central 5'' (410 pc) is elongated along position angle (P.A.) \approx 72\arcdeg, which is roughly parallel to two nuclear dust lanes.Our high-resolution images reveal that the H$\alpha$ + [N II] emission has three components, namely a nuclear gas disk,an `ionization cone', and outer filaments. The nuclear disk of ionized gas has diameter $\approx 1'' = 82$ pc and major axis P.A. \approx 58\arcdeg \pm 6\arcdeg. On an angular scale of 0\farcs5, the major axis of this nuclear gas disk is consistent with that of the dust. However, the minor axis of the gas disk (P.A. \approx 148\arcdeg) is tilted with respect to that of the filamentary H$\alpha$ + [N II] emission at distances > 2'' from the nucleus; the minor axis of this larger scale gas is roughly aligned with the axis of the kpc-scale radio jets (P.A. \approx 170\arcdeg). The ionization cone (whose apex is offset by \approx 0\farcs3 south of the nucleus) extends 2'' from the nucleus along the axis of the southern radio jet. This feature is similar to the ionization cones seen in some Seyfert nuclei, which are also aligned with the radio axes.Comment: 11 pages plus 4 figure

Cyclones, tides, and the origin of a cross-equatorial dust storm on Mars

We investigate the triggering mechanism of a cross-equatorial dust storm observed by Mars Global Surveyor in 1999. This storm, which had a significant impact on global mean temperatures, was seen in visible and infrared data to commence with the transport of linear dust fronts from the northern high latitudes into the southern tropics. However, other similar transport events observed in northern fall and winter did not lead to large dust storms. Based on off-line Lagrangian particle transport analysis using a high resolution Mars general circulation model, we propose a simple explanation for the diurnal, seasonal and interannual variability of this type of frontal activity, and of the resulting dust storms, that highlights the cooperative interaction between northern hemisphere fronts associated with low pressure cyclones and tidally-modified return branch of the Hadley circulation