Modeling the cost–benefit of nerve conduction studies in pre-employment screening for carpal tunnel syndrome

OBJECTIVES: To evaluate the costs associated with pre-employment nerve conduction testing as a screening tool for carpal tunnel syndrome (CTS) in the workplace. METHODS: We used a Markov decision analysis model to compare the costs associated with a strategy of screening all prospective employees for CTS and not hiring those with abnormal nerve conduction, versus a strategy of no screening for CTS. The variables included in our model included employee turnover rate, the incidence of CTS, the prevalence of median nerve conduction abnormalities, the relative risk of developing CTS conferred by abnormal NCS, the costs of pre-employment screening, and the workers' compensation costs to the employer for a case of CTS. RESULTS: In our base case, total employer costs for CTS from the perspective of the employer (cost of screening plus costs for workers' compensation associated with CTS) were higher when screening was used. Median costs per employee position over five years were $503 for the screening strategy vs.$200 for a strategy of no screening. Sensitivity analysis showed that a strategy of screening was cost-beneficial from the perspective of the employer only under a few circumstances. In Monte Carlo simulation varying all parameters, we found a 30% probability that screening would be cost-beneficial. CONCLUSIONS: A strategy of pre-employment screening for CTS should be carefully evaluated for yield and social consequences before being implemented. Our model suggests such screening is not appropriate for most employers

Exploratory Insights into Cross-Cultural On-line Shopping Differences between U.S. and French Millennials and Generation Zs

Online retail sales have shown double-digit growth in the U.S. for the last decade lead by millennials and more recently generation Z. While extensive research has been done exploring U.S. online shopping behaviors of these generations, little cross-cultural work has been done. This paper explores the differences between the U.S. and French millennial and gen z online shoppers. The research focused on four questions; was there a difference in the number of times per week that individuals shopped online, the percentage of shopping funds spent online versus in store, the types of products purchased online, and the percentage of low priced products (below $25 or €25. Results showed significant differences between the online shopping and purchasing behaviors between French and U.S. online shoppers

Viscoelastic Response of the Titanium Alloy Ti-6-4: Experimental Identification of Time- and Rate-Dependent Reversible and Irreversible Deformation Regions

In support of an effort on damage prognosis, the viscoelastic behavior of Ti-6Al-4V (Ti-6-4) was investigated. This report documents the experimental characterization of this titanium alloy. Various uniaxial tests were conducted to low load levels over the temperature range of 20 to 538 C to define tensile, creep, and relaxation behavior. A range of strain rates (6x10(exp -7) to 0.001/s) were used to document rate effects. All tests were designed to include an unloading portion, followed by a hold time at temperature to allow recovery to occur either at zero stress or strain. The titanium alloy was found to exhibit viscoelastic behavior below the "yield" point and over the entire range of temperatures (although at lower temperatures the magnitude is extremely small). These experimental data will be used for future characterization of a viscoelastic model

Viscoplastic Characterization of Ti-6-4: Experiments

As part of a continued effort to improve the understanding of material time-dependent response, a series of mechanical tests have been conducted on the titanium alloy, Ti-6Al-4V. Tensile, creep, and stress relaxation tests were performed over a wide range of temperatures and strain rates to engage various amounts of time-dependent behavior. Additional tests were conducted that involved loading steps, overloads, dwell periods, and block loading segments to characterize the interaction between plasticity and time-dependent behavior. These data will be used to characterize a recently developed, viscoelastoplastic constitutive model with a goal toward better estimates of aerospace component behavior, resulting in improved safety

Utilities for Quantifying Separation in PCA/PLS-DA Scores Plots

Metabolic fingerprinting studies rely on interpretations drawn from low-dimensional representations of spectral data generated by methods of multivariate analysis such as PCA and PLS-DA. The growth of metabolic fingerprinting and chemometric analyses involving these lowdimensional scores plots necessitates the use of quantitative statistical measures to describe significant differences between experimental groups. Our updated version of the PCAtoTree software provides methods to reliably visualize and quantify separations in scores plots through dendrograms employing both nonparametric and parametric hypothesis testing to assess node significance, as well as scores plots identifying 95% confidence ellipsoids for all experimental groups

Cavallo's Multiplier for in situ Generation of High Voltage

A classic electrostatic induction machine, Cavallo's multiplier, is suggested for in situ production of very high voltage in cryogenic environments. The device is suitable for generating a large electrostatic field under conditions of very small load current. Operation of the Cavallo multiplier is analyzed, with quantitative description in terms of mutual capacitances between electrodes in the system. A demonstration apparatus was constructed, and measured voltages are compared to predictions based on measured capacitances in the system. The simplicity of the Cavallo multiplier makes it amenable to electrostatic analysis using finite element software, and electrode shapes can be optimized to take advantage of a high dielectric strength medium such as liquid helium. A design study is presented for a Cavallo multiplier in a large-scale, cryogenic experiment to measure the neutron electric dipole moment.Comment: 9 pages, 10 figure

Experimental Identification and Simulation of Time and/or Rate Dependent Reversible and Irreversible Deformation Regions for both a Titanium and Nickel Alloy

In this paper time and/or rate dependent deformation regions are experimentally mapped out as a function of temperature. It is clearly demonstrated that the concept of a threshold stress (a stress that delineate reversible and irreversible behavior) is valid and necessary at elevated temperatures and corresponds to the classical yield stress at lower temperatures. Also the infinitely slow modulus, (Es) i.e. the elastic modulus of the material if it was loaded at an infinitely slow strain rate, and the "dynamic modulus", modulus, Ed, which represents the modulus of the material if it is loaded at an infinitely fast rate are used to delineate rate dependent from rate independent regions. As demonstrated at elevated temperatures there is a significant difference between the two modulus values, thus indicating both significant time-dependence and rate dependence. In the case of the nickel-based super alloy, ME3, this behavior is also shown to be grain size specific. Consequently, at higher temperatures viscoelastic behavior exist below k (i.e., the threshold stress) and at stresses above k the behavior is viscoplastic. Finally a multi-mechanism, stress partitioned viscoelastic model, capable of being consistently coupled to a viscoplastic model is characterized over the full temperature range investigated for Ti-6-4 and ME3

Task Control Signals in Pediatric Tourette Syndrome Show Evidence of Immature and Anomalous Functional Activity

Tourette Syndrome (TS) is a pediatric movement disorder that may affect control signaling in the brain. Previous work has proposed a dual-networks architecture of control processing involving a task-maintenance network and an adaptive control network (Dosenbach et al., 2008). A prior resting-state functional connectivity MRI (rs-fcMRI) analysis in TS has revealed functional immaturity in both putative control networks, with “anomalous” correlations (i.e., correlations outside the typical developmental range) limited to the adaptive control network (Church et al., 2009). The present study used functional MRI (fMRI) to study brain activity related to adaptive control (by studying start-cues signals), and to task-maintenance (by studying signals sustained across a task set). Two hypotheses from the previous rs-fcMRI results were tested. First, adaptive control (i.e., start-cue) activity will be altered in TS, including activity inconsistent with typical development (“anomalous”). Second, group differences found in task-maintenance (i.e., sustained) activity will be consistent with functional immaturity in TS. We examined regions found through a direct comparison of adolescents with and without TS, as well as regions derived from a previous investigation that showed differences between unaffected children and adults. The TS group showed decreased start-cue signal magnitude in regions where start-cue activity is unchanged over typical development, consistent with anomalous adaptive control. The TS group also had higher magnitude sustained signals in frontal cortex regions that overlapped with regions showing differences over typical development, consistent with immature task-maintenance in TS. The results demonstrate task-related fMRI signal differences anticipated by the atypical functional connectivity found previously in adolescents with TS, strengthening the evidence for functional immaturity and anomalous signaling in control networks in adolescents with TS