The Pelvis and Beyond: Musculoskeletal Tender Points in Women With Chronic Pelvic Pain

To determine the feasibility of a detailed pain sensitivity assessment using body wide musculoskeletal tender points (TPs) in women with different types of chronic pelvic pain (CPP) and compare phenotypic differences

A longitudinal analysis of urological chronic pelvic pain syndrome flares in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151272/1/bju14783.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151272/2/bju14783_am.pd

Cyclic vomiting syndrome in adults

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72300/1/j.1365-2982.2008.01113.x.pd

Not All Managers Are Managerial: A Self-Evaluation of Women Middle-Managers' Experiences in a UK University

The focus of this small-scale self-evaluation is the implementation of a new middle-management role in a post-92 UK university. A realist appreciative inquiry was undertaken with five women who had been promoted to a middle-management role 18 months prior to the inquiry. This evaluation for knowledge offered an opportunity to reflect on experiences in practice and sought to understand the experiences of the women in this role and how they cope with the challenges middle-management brings. Particular challenges (instability-generating) accorded with existing literature and included: lack of role clarity, lack of pre-preparation for management role, colleagues’ views of management, including perceptions of women in management roles and malicious intent of managed academics in rare cases. Supportive factors (provisional-stability-generating) included: personal resilience, informal peer support, external support and reflection. The co-evaluators offered reflections for the future from this co-evaluation. These suggest that training may contribute to provisional-stability in role and should be considered for new entrants to middle-management. The alternative construct of humanistic management is proposed as a way of understanding these women’s values-based decision-making practices in complex situations

Evaluation for what purpose? Findings from two stakeholder groups

A host of reasons exist for the pursuit of evidence in the public sector, including to support good governance and policy development. As the expectations for program evaluation from policymakers have evolved, so too has evaluation practice and a great deal of experimentalism has ensued. There is a risk that these developments and the complexity inherent in them, may lead to conflicting expectations about why program evaluation is done, or even a loss of purpose. This prompts the meso-level analysis of two types of stakeholders in a governance network, explored in this chapter. This chapter presents the findings of an ongoing study which explores the perceptions of program evaluators and policy implementers towards the purpose of evidence. The findings suggest that program evaluators and policy implementers have divergent expectations of why and how evaluation data might be used. The findings suggest that program evaluators aspire to support change and enhance the policy domains they serve, whereas policy implementers perceive program evaluation as serving a more governance-/management-orientated role. The chapter demonstrates the complexity of both program evaluation and policy and may have implications for the twin pillars of governance and responsibility at the heart of the book. If governance and responsibility are the twin pillars of sustainability then the complex networks of relationships, expectations, values, and outcomes may need to be considered. The findings also have implications for evaluation commissioners and practitioners, demonstrating the need for the purpose and expectations of program evaluation to be agreed early. The use of program evaluation as a symbolic, aesthetic or structural mechanism also emerges, prompting opportunity for further research, for instance, to explore legitimacy and program evaluation.N/

Autonomic nervous system testing may not distinguish multiple system atrophy from Parkinson's disease

Background: Formal laboratory testing of autonomic function is reported to distinguish between patients with Parkinson's disease and those with multiple system atrophy (MSA), but such studies segregate patients according to clinical criteria that select those with autonomic dysfunction for the MSA category. Objective: To characterise the profiles of autonomic disturbances in patients in whom the diagnosis of Parkinson's disease or MSA used criteria other than autonomic dysfunction. Methods: 47 patients with parkinsonism and autonomic symptoms who had undergone autonomic laboratory testing were identified and their case records reviewed for non-autonomic features. They were classified clinically into three diagnostic groups: Parkinson's disease (19), MSA (14), and uncertain (14). The performance of the patients with Parkinson's disease was compared with that of the MSA patients on five autonomic tests: RR variation on deep breathing, heart rate changes with the Valsalva manoeuvre, tilt table testing, the sudomotor axon reflex test, and thermoregulatory sweat testing. Results: None of the tests distinguished one group from the other with any statistical significance, alone or in combination. Parkinson's disease and MSA patients showed similar patterns of autonomic dysfunction on formal testing of cardiac sympathetic and parasympathetic, vasomotor, and central and peripheral sudomotor functions. Conclusions: This study supports the clinical observation that Parkinson's disease is often indistinguishable from MSA when it involves the autonomic nervous system. The clinical combination of parkinsonism and dysautonomia is as likely to be caused by Parkinson's disease as by MSA. Current clinical criteria for Parkinson's disease and MSA that direct patients with dysautonomia into the MSA group may be inappropriate

Abstract 103: Acute Onset Rhythmic Tremor In Acute Frontal Cortical Infarction: A Case Report

Introduction Acute ischemic stroke varies in presentation, and it is crucial to quickly identify patients presenting with stroke for timely intervention. Secondary movement disorders occurring after a delayed period following ischemic stroke have been well‐documented, though rare. Holmes tremor specifically has been described as a delayed result of ischemic infarction involving subcortical structures such as mollaret triangle, thalamus, and basal ganglia. However, it is novel for frontal cortical infarcts to present with acute‐onset contralateral limb tremor, especially as an isolated symptom. Our case suggests a “secondary insult” involving the frontal cortex can disinhibit the motor pathway that leads to tremor in preexisting midbrain and thalamic lesions. We present a 67‐year‐old male with acute onset, constant, rhythmic tremor in the setting of acute ischemic frontal cortical infarction. Methods n/a, case report Results A 67‐year‐old male with medical history of pineal gland cyst status‐post shunt placement and hypertension who presented for evaluation of acute onset right upper extremity rhythmic tremor that started 24 hours prior. He did not have any associated weakness, numbness, vision changes, nausea, or vomiting. He had never had this tremor before. Neurologic examination was significant for a 4.0 Hz rhythmic resting tremor that was present throughout exam and was non‐distractible. This tremor remained consistent even with kinetic movements and postures. Electroencephalogram (EEG) was performed STAT during this tremor and was not based in seizure. Non‐contrast head computerized tomography (CT) was negative for any acute hemorrhage or intracranial pathology. CT angiogram head and neck showed left internal carotid artery (ICA) long segment tapered occlusion from the proximal cervical ICA to the distal petrous segment, likely dissection of undetermined chronicity. Magnetic resonance imaging (MRI) Brain with and without contrast was significant for acute punctate foci involving the precentral cortex of the left frontal lobe consistent with acute ischemic infarction. Encephalomalacia was also present involving the bilateral posterior thalami and left midbrain chronic ischemic infarctions. This suggests the tremor was caused by disinhibition of the motor pathway from the ischemic insult to the frontal cortex, as he had pre‐existing asymptomatic ischemic insult to the typical structures known to cause this tremor. He was outside of the Tenecteplase window and was given a load of Aspirin followed by aspirin 81 mg daily. He was trialed on propranolol for treatment of symptomatic tremor however this was discontinued before discharge as it was ineffective and patient preferred to hold off on other treatments. He is now awaiting outpatient Neurology follow up. Conclusion This case suggests that acute onset Holmes tremor can be the sole presenting sign in acute ischemic frontal cortical infarction. The pre‐existing asymptomatic infarctions in the midbrain and thalamus also support that a “second hit” located in the frontal cortex can disinhibit the motor pathway between the cortex and rubral tract. This is important as Holmes tremor is more commonly known to be from a mechanism of damage to the red nucleus or thalamic structures in a delayed manner, typically at least two weeks after stroke. This knowledge will help identify rare strokes in a timely manner