What is the best diagnostic approach to paresthesias of the hand?

There have been no good studies comparing different strategies for the evaluation of the patient with hand paresthesias. A reasonable strategy is to first evaluate for carpal tunnel syndrome (CTS), the most common condition associated with hand paresthesias. If the patient does not have findings consistent with CTS, then consider other diagnoses (Table). (Grade of recommendation: D, based on expert opinion.) Findings consistent with CTS include a history of repetitive hand work, asymmetric paresthesias in the distribution of the median nerve, hypoalgesia, weak thumb abduction, or latency of nerve conduction studies. Tingling in the median nerve distribution or on the entire palmar surface also supports the diagnosis. Common conditions associated with CTS are pregnancy, obesity, and hypothyroidism. (Grade of recommendation: B, systematic review of case control studies)

Life without Parole for Juvenile Offenders: Questions of Legality and Adolescent Culpability

Life without parole for juvenile offenders is a controversial issue across the globe. Recently, the United States stands alone as the only country in the world that allows juvenile offenders to be sentenced to life time confinement without the possibility of parole. Furthermore, the U.S. has seen an increase in juvenile waivers and blended sentences, which has resulted in harsher penalties for juvenile offenders who have committed serious and violent crimes. This analysis examines scientific evidence that shows juveniles are different from adults in terms of brain development, rational decision making abilities, and maturity levels. These findings have questioned the reasoning behind imposing adult punishment on adolescent behavior. This analysis also presents the legal arguments suggesting that juvenile life without parole is unconstitutional and violates the Eighth and Fourteenth Amendments. Arguments for and against life sentences were also presented. This study concludes with a discussion of policy implications, whether the U.S. Supreme Court should abolish juvenile life without parole sentencing practices and explores the possible future direction of juvenile sentencing in the United States