A case report of a patient with upper extremity symptoms: differentiating radicular and referred pain

<p>Abstract</p> <p>Background</p> <p>Similar upper extremity symptoms can present with varied physiologic etiologies. However, due to the multifaceted nature of musculoskeletal conditions, a definitive diagnosis using physical examination and advanced testing is not always possible. This report discusses the diagnosis and case management of a patient with two episodes of similar upper extremity symptoms of different etiologies.</p> <p>Case Presentation</p> <p>On two separate occasions a forty-four year old female patient presented to a chiropractic office with a chief complaint of insidious right-sided upper extremity symptoms. During each episode she reported similar pain and parasthesias from her neck and shoulder to her lateral forearm and hand.</p> <p>During the first episode the patient was diagnosed with a cervical radiculopathy. Conservative treatment, including manual cervical traction, spinal manipulation and neuromobilization, was initiated and resolved the symptoms.</p> <p>Approximately eighteen months later the patient again experienced a severe acute flare-up of the upper extremity symptoms. Although the subjective complaint was similar, it was determined that the pain generator of this episode was an active trigger point of the infraspinatus muscle. A diagnosis of myofascial referred pain was made and a protocol of manual trigger point therapy and functional postural rehabilitative exercises improved the condition.</p> <p>Conclusion</p> <p>In this case a thorough physical evaluation was able to differentiate between radicular and referred pain. By accurately identifying the pain generating structures, the appropriate rehabilitative protocol was prescribed and led to a successful outcome for each condition. Conservative manual therapy and rehabilitative exercises may be an effective treatment for certain cases of cervical radiculopathy and myofascial referred pain.</p

It’s only rock ‘n roll (but I like it): Chord perception and rock’s liberal harmonic palette

© The Author(s) 2019. Both music-theoretic accounts and corpus analyses indicate that rock routinely employs chords that deviate from the norms of common-practice music. Yet we know little about how listeners experience the chords that make up rock’s liberal harmonic palette. In the present study, participants in two online experiments rated major chords that followed a short tonal sequence (a major scale + tonic major triad). Liking ratings obtained in Experiment 1 replicated earlier work showing that listeners prefer rock-typical targets—chords that are common in rock, but lie outside the basic diatonic set—to atypical, rarely used targets (Craton, Juergens, Michalak, & Poirier, 2016). Goodness of fit ratings with the same stimuli in Experiment 2 were similar to the liking ratings. High ratings for rock-typical target chords across the two experiments were not an artifact of their register and the pattern of responses was similar across four levels level of music training. In addition, the mean fitness ratings were approximated by simulations conducted with an auditory short-term memory (ASTM) model (Leman, 2000). Considered together, the findings provide evidence that listeners perceive rock-typical chords to be normal components of a key and that they may do so based on information in the auditory signal alone, without recourse to statistical learning mechanisms or representations of tonal knowledge. We speculate that bottom-up processes operating directly on the auditory signal create a perceptual ranking of chord fitness, which provides the harmonic palette from which composers/improvisers in different musical systems may conservatively (common-practice) or liberally (rock) choose. The mean data are available in tabular form for modelers in the online supplemental material

1,050 years of Hurricane Strikes on Long Island in The Bahamas

Sedimentary records of past hurricane activity indicate centennial-scale periods over the past millennium with elevated hurricane activity. The search for the underlying mechanism behind these active hurricane periods is confounded by regional variations in their timing. Here, we present a new high resolution paleohurricane record from The Bahamas with a synthesis of published North Atlantic records over the past millennium. We reconstruct hurricane strikes over the past 1,050 years in sediment cores from a blue hole on Long Island in The Bahamas. Coarse-grained deposits in these cores date to the close passage of seven hurricanes over the historical interval. We find that the intensity and angle of approach of these historical storms plays an important role in inducing storm surge near the site. Our new record indicates four active hurricane periods on Long Island that conflict with published records on neighboring islands (Andros and Abaco Island). We demonstrate these three islands do not sample the same storms despite their proximity, and we compile these reconstructions together to create the first regional compilation of annually resolved paleohurricane records in The Bahamas. Integrating our Bahamian compilation with compiled records from the U.S. coastline indicates basin-wide increased storminess during the Medieval Warm Period. Afterward, the hurricane patterns in our Bahamian compilation match those reconstructed along the U.S. East Coast but not in the northeastern Gulf of Mexico. This disconnect may result from shifts in local environmental conditions in the North Atlantic or shifts in hurricane populations from straight-moving to recurving storms over the past millennium

Nicotine Fast Dissolving Films Made of Maltodextrins: A Feasibility Study

This work aimed to develop a fast-dissolving film made of low dextrose equivalent maltodextrins (MDX) containing nicotine hydrogen tartrate salt (NHT). Particular attention was given to the selection of the suitable taste-masking agent (TMA) and the characterisation of the ductility and flexibility under different mechanical stresses. MDX with two different dextrose equivalents (DEs), namely DE 6 and DE 12, were selected in order to evaluate the effect of polymer molecular weight on film tensile properties. The bitterness and astringency intensity of NHT and the suppression effect of several TMA were evaluated by a Taste-Sensing System. The films were characterised in term of NHT content, tensile properties, disintegration time and drug dissolution test. As expected, placebo films made of MDX DE 6 appeared stiffer and less ductile than film prepared using MDX DE 12. The films disintegrated within 10 s. Among the tested TMA, the milk and mint flavours resulted particularly suitable to mask the taste of NHT. The addition of NHT and taste-masking agents affected film tensile properties; however, the effect of the addition of these components can be counterweighted by modulating the glycerine content and/or the MDX molecular weight. The feasibility of NHT loaded fast-dissolving films was demonstrated