Igniting concern about refugee injustice

Injustice is a prominent theme in the news but there is far less attention to how to be effective in opposing it. For activists, it is crucial to understand how reactions against injustice can be ignited and/or inhibited. Injustice towards refugees provides a revealing case study

A linked data approach to publishing complex scientific workflows

Past data management practices in many fields of natural science, including climate research, have focused primarily on the final research output - the research publication - with less attention paid to the chain of intermediate data results and their associated metadata, including provenance. Data were often regarded merely as an adjunct to the publication, rather than a scientific resource in their own right. In this paper, we attempt to address the issues of capturing and publishing detailed workflows associated with the climate/research datasets held by the Climatic Research Unit (CRU) at the University of East Anglia. To this end, we present a customisable approach to exposing climate research workflows for the effective re-use of the associated data, through the adoption of linked-data principles, existing widely adopted citation techniques (Digital Object Identifier) and data exchange mechanisms (Open Archives Initiative Object Reuse and Exchange)

Capturing cases of distal symmetric polyneuropathy in a community

Introduction: Little is known about what constitutes appropriate diagnostic testing in patients with distal symmetric polyneuropathy (DSP). Methods: Utilizing an ICD‐9 screening method and medical record abstraction, we determined the number of new cases of DSP within community neurology practices in Nueces County, Texas. We then compared 2 case capture methods (ICD‐9 vs. all‐case review screening). Results: The ICD‐9 case capture method identified 52 cases over a 3‐month period. Comparing case capture methods, the ICD‐9 method identified 16 of 17 cases identified by the all‐case review method (94%). The ICD‐9 method required screening of 84% fewer charts compared with the all‐case review. Conclusions: Many new cases of DSP occur each month within Nueces County. The ICD‐9 screening technique combined with medical abstraction is an efficient method to identify new DSP cases in this community. These findings are critical for future epidemiological investigations into patients with DSP. Muscle Nerve, 2012Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94499/1/23449_ftp.pd

Randomized controlled trial of a clinical decision support system for painful polyneuropathy

IntroductionDespite the existence of guidelines, painful neuropathy is often inappropriately treated. We sought to determine the effectiveness of a clinical decision support system on guideline‐recommended medication use.MethodsWe randomized neurology providers, stratified by subspecialty, to a best practice alert (BPA) linked to a Smartset or a BPA alone when seeing patients with neuropathy. The primary outcome was the proportion of patients with uncontrolled nerve pain prescribed a guideline‐recommended medication. Generalized estimating equations were used to assess effectiveness.ResultsSeventy‐five neurology providers (intervention 38, control 37) treated 2697 patients with neuropathy (intervention 1026, control 671). Providers did not acknowledge the BPA in 1928 (71.5%) visits. Only four of eight intervention arm neurologists who treated patients with uncontrolled nerve pain opened the Smartset. The intervention was not associated with guideline‐recommended medication use (odds ratio 0.52, 0.18‐1.48; intervention 52%, control 54.8%).DiscussionOur intervention did not improve prescribing practices for painful neuropathy. Physicians typically ignored the BPAs/Smartset; therefore, future studies should mandate their use or employ alternate strategies.See editorial on pages 552–553 in this issue.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154934/1/mus26774.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154934/2/mus26774_am.pd

Choosing Wisely: Highest‐cost tests in outpatient neurology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98329/1/ana23865.pd

Reply

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106672/1/ana24034.pd

Looming struggles over technology for border control

New technologies under development, capable of inflicting pain on masses of people, could be used for border control against asylum seekers. Implementation might be rationalized by the threat of mass migration due to climate change, nuclear disaster or exaggerated fears of refugees created by governments. We focus on taser anti-personnel mines, suggesting both technological countermeasures and ways of making the use of such technology politically counterproductive. We also outline several other types of ‘non-lethal’ technology that could be used for border control and raise human rights concerns: high-powered microwaves, armed robots, wireless tasers, acoustic devices/vortex rings, ionizing and pulsed energy lasers, chemical calmatives, convulsants, bioregulators and malodurants. Whether all these possible border technologies will be implemented is a matter for speculation, but their serious human rights implications warrant advance scrutiny

Exercise prescription improves exercise tolerance in young children with CHD:a randomised clinical trial

Objective The main objective of this study was to ascertain if a structured intervention programme can improve the biophysical health of young children with congenital heart disease (CHD). The primary end point was an increase in measureable physical activity levels following the intervention.Methods Patients aged 5–10 years with CHD were identified and invited to participate. Participants completed a baseline biophysical assessment, including a formal exercise stress test and daily activity monitoring using an accelerometer. Following randomisation, the intervention group attended a 1 day education session and received an individual written exercise plan to be continued over the 4-month intervention period. The control group continued with their usual level of care. After 4 months, all participants were reassessed in the same manner as at baseline.Results One hundred and sixty-three participants (mean age 8.4 years) were recruited, 100 of whom were male (61.3%). At baseline, the majority of the children were active with good exercise tolerance. The cyanotic palliated subgroup participants, however, were found to have lower levels of daily activity and significantly limited peak exercise performance compared with the other subgroups. One hundred and fifty-two participants (93.2%) attended for reassessment. Following the intervention, there was a significant improvement in peak exercise capacity in the intervention group. There was also a trend towards increased daily activity levels.Conclusion Overall physical activity levels are well preserved in the majority of young children with CHD. A structured intervention programme significantly increased peak exercise capacity and improved attitudes towards positive lifestyle changes

Electromyography‐related pain: Muscle selection is the key modifiable study characteristic

Introduction : The aim of this study was to estimate the effects of patient, provider, and study characteristics on electromyography (EMG)‐related pain. Methods : Patients undergoing EMG rated their EMG‐related pain after each muscle was studied on a 100‐point visual analog scale (VAS). Investigators recorded the order in which the muscles were sampled, the total time spent with the needle in each muscle, and whether electrical endplate noise was noted. Results : A total of 1781 muscles were studied in 304 patients. Eleven muscles were associated with significantly more or less pain than the others. Endplate noise was associated with more pain (5.4 mm, 95% CI 2.8–7.0). There was a small, but significant effect from needling time (0.02 mm, 95% CI 0.00–0.04). Conclusions : Among factors that electromyographers can control, muscle selection has the greatest impact on pain. Our data include an extensive list of muscle‐specific EMG‐related pain scores. Provider and other study characteristics have little or no impact on EMG‐related pain. Muscle Nerve 49:570–574, 2014Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106736/1/mus23974.pd

Bilateral nerve conduction studies in the evaluation of distal symmetric polyneuropathy

IntroductionNerve conduction studies are used to aid in the diagnosis of distal symmetric polyneuropathy (DSP). It is unclear whether bilateral lower extremity nerve conduction studies (NCS) are needed when evaluating for suspected DSP.MethodsWe retrospectively analyzed NCS from patients who presented to the University of Michigan electromyography laboratory between July 1, 2016 and December 31, 2017 with symptoms of DSP to assess agreement and correlation between left and right lower extremity NCS parameters.ResultsWe found significant agreement between abnormalities in individual nerve parameters of the left and right lower extremities of 105 patients, most notably in the sural nerve. In the 53 patients with bilateral sural, peroneal, and tibial studies, there was also significant agreement between whether the left and right met electrodiagnostic criteria for DSP (κ = 0.77).DiscussionBilateral lower extremity NCS may have limited utility in the evaluation of suspected DSP. Muscle Nerve, 2019Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151276/1/mus26616.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151276/2/mus26616_am.pd