The Morphology of the Axillary Border of the Scapula With Special Reference to the Neandertal Problem

Controversy concerning Neandertal man’s place in anatomically modern man’s ancestry continues today, 120 years after the discovery of the first Neandertal at Dusseldorf. The major emphasis of this controversy concerns the cranium. In the postcranial material, however, there are two areas which exhibit morphological differences from modern man, all other postcranial features being within the ranges of variation of modern man. These two different postcranial features are: the morphology of the superior pubic ramus of the innominate and the morphology of the axillary border of the scapula. This thesis is concerned with the latter feature. While the axillary borders of modern men commonly exhibit a ventral groove, two-thirds of the known Neandertal scapulae where the axillary border is preserved exhibit a double sulcus, or bisulcate pattern. This latter type was first noted on the axillary border of the Upper Paleolithic specimen from Chancelade. This Chancelade-type morphology occurs much more frequently in Upper Paleolithic hominids than in modern populations. The ventral or modern type is seen in one Upper Paleolithic specimen and has never been seen with certainty among Neandertals. The purpose of this thesis is to test hypotheses concerning the changes on the axillary borders of scapulae between Neandertal and modern man. Comparative material used in this study was drawn from skeletal material of Arikara American Indians which are housed in the Osteological Laboratory of the Department of Anthropology at the University of Tennessee, Knoxville. Correlations between various scapular axillary border morphologies with respect to age, sex and side were sought. Relationships between the various axillary border morphologies and the angle of the glenoid fossa, as well as the index of the glenoid fossa, were tested, but consistent correlations were not found. Positive correlations were found between the robusticity of the infraglenoid tubercles and axillary border morphologies, as well as between border morphologies, and associated humeral head angles. The results of this investigation suggest that the morphology of the axillary border of the scapula is a function of use. The incidence of the Chancelade type is generally greater with advancing age and on the right side. This indicates ontogenetic causes for the varying morphologies. Correlations between varying morphologies and humeral head indices and head/shaft angles indicate that varying scapula-humeral relationships influence the morphology of the axillary border of the scapula. In Neandertals, the barrel-shaped thorax appears to have resulted in scapulohumeral musculoskeletal relationships in the shoulder area which could have caused greater stress to be exerted on the teres minor muscle, thus creating the dorsal groove on the axillary border of the scapula. It is suggested that the differences in morphological patterns on the axillary border of the scapula found between Neandertal and modern man can be functionally explained by (1) differences in the scapulohumeral relationship, and (2) greater biomechanical stress in the shoulder area of Neandertals than that of modern man due to the difference in cultural adaptations

Morphological Changes on the Axillary Border of the Scapula with Special Reference to the Neandertal Problem

This study is an effort to determine the causes of the various morphologies of the axillary border of the modern human scapula and to relate the results to the unusual morphology of Neandertal scapulae. Two-thirds of known Neandertal scapulae exhibit a dorsal sulcus on the axillary border: the remainder have a double sulcus (Chancelade pattern) and only one exhibits a ventral sulcus. The ventral sulcus is predominant on the scapulae of anatomically modern hominids where the Chancelade pattern is also present in varying frequencies. Quantitative and qualitative analyses were performed on data derived from skeletal material of five modern human groups in order to determine the causes of morphological changes on the axillary border of the scapula. The groups are: blacks and whites from a documented hospital collection (Terry Collection); Alaskan Eskimos; Southeastern American Indians of the Mississippian period, and of the Archaic period. The groups varied with respect to race, time and technological level. Greater frequencies of the Chancelade pattern were found with advancing age and on the right side in these groups. It is suggested that, in modern humans, increased muscular stress, resulting from increased use of the upper limb, promotes greater development of the teres minor muscle as seen in the Chancelade morphology. Additionally, in modern hominids, the Chancelade pattern is positively associated with more curved clavicles (indicating a slightly rounder thorax) and with more cranially deviated humeral heads. Thus, it is further suggested that the rounder thorax of Neandertals may have caused their scapulohumeral-musculoskeletal relationships to be different from those of modern hominids. This effect together with the more strenuous use of the upper limbs (due to greater demands of the cultural level) may have caused enlargement of the teres minor muscle, thus creating a dorsal sulcus on most Neandertal scapulae. Other factors contributing to the morphological changes from Neandertals to modern hominids may have been cultural changes which produced differences in tool and weapon handling, and/or genetic selection

Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review.

BACKGROUND: In palliative care patients, fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of life. Further complicating issues are the multidimensionality, subjective nature and lack of a consensus definition of fatigue. The review aimed to evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases. METHODS: We considered randomized controlled trials concerning adult palliative care with a focus on pharmacological treatment of fatigue compared with placebo, application of two drugs, usual care or a non-pharmacological intervention. The primary outcome had to be non-specific fatigue (or related terms such as asthenia). We searched the CENTRAL, MEDLINE, PsycINFO and EMBASE, and a selection of cancer journals up to 28 April 2014. Two review authors independently assessed trial quality and extracted the data. RESULTS: We screened 1645 publications of which 45 met the inclusion criteria. In total, we analysed data from 18 drugs and 4696 participants. There was a very high degree of statistical and clinical heterogeneity in the trials. Meta-analysis of data was possible for modafinil, pemoline, and methylphenidate. CONCLUSIONS: Due to the limited evidence, we cannot recommend a specific drug for the treatment of fatigue in palliative care patients. Some drugs, which may be beneficial for the treatment of fatigue associated with palliative care such as amantadine, methylphenidate, and modafinil, should be further researched

High-gradient operators in perturbed Wess-Zumino-Witten field theories in two dimensions

Many classes of non-linear sigma models (NLSMs) are known to contain composite operators with an arbitrary number 2s of derivatives ("high-gradient operators") which appear to become strongly relevant within RG calculations at one (or fixed higher) loop order, when the number 2s of derivatives becomes large. This occurs at many conventional fixed points of NLSMs which are perturbatively accessible within the usual epsilon-expansion in d=2+\epsilon dimensions. Since such operators are not prohibited from occurring in the action, they appear to threaten the very existence of such fixed points. At the same time, for NLSMs describing metal-insulator transitions of Anderson localization in electronic conductors, the strong RG-relevance of these operators has been previously related to statistical properties of the conductance of samples of large finite size ("conductance fluctuations"). In this paper, we analyze this question, not for perturbative RG treatments of NLSMs, but for 2d Wess-Zumino-Witten (WZW) models at level k, perturbatively in the current-current interaction of the Noether current. WZW models are special ("Principal Chiral") NLSMs on a Lie Group G with a WZW term at level k. In these models the role of high-gradient operators is played by homogeneous polynomials of order 2s in the Noether currents, whose scaling dimensions we analyze. For the Lie Supergroup G=GL(2N|2N) and k=1, this corresponds to time-reversal invariant problems of Anderson localization in the so-called chiral symmetry classes, and the strength of the current-current interaction, a measure of the strength of disorder, is known to be completely marginal (for any k). We find that all high-gradient (polynomial) operators are, to one loop order, irrelevant or relevant depending on the sign of that interaction.Comment: 22 page

Atemmuskelfunktion bei Myasthenia gravis pseudoparalytica

Background and objective Myasthenia gravis is a post-synaptic disorder of neuromuscular transmission, triggered by auto­antibodies. Acute deterioration of the disease (myasthenic crisis) is characterized by a weakness of respiratory muscles until the need for mechanical ventilation. The treatment with corticosteroids, immunosuppressants (azathioprine), acetyl-choline esterase inhibitors reduced the previously high mortality of that disease in a detectable way. This study was designed, to evaluate frequency and severity of respiratory disturbances in an unselected group of MG patients. Furthermore it was designed to assess the correlation of respiratory disorders, disease severity and the titer of acetyl-choline receptor antibodies. Patients and methods 30 patients (17 women) reliably diagnosed as having myasthenia gravis were examined. Besides a general neurological assessment was undertaken with quantification of myasthenic symptoms using Besinger's score. In addition the following were undertaken: Lung function examination (FVC in sitting and supine posture, FEV1) was performed, including maximum voluntary airway pressures (PImax, PEmax). Cardio-respiratory polygraphy was performed. Individual patients underwent polysomnography. Quality of life and disability in everyday life was assessed using Barthel's index, Epworth Sleepiness Scale, Hamilton Depression Scale (HDS). Results The mean age of the patients was 52.5 (+/-18.5) years, the mean duration of the disease was 58 (+/-54) months, the mean score according to Besinger 5 (+/-3,71) pts. 20 of the patients were found to be in stage 2b according to Ossermann’s classification, 18 had undergone a thymectomy. 7 (23%) were suffering from at least one accompanying cardiopulmonary disease. 9 patients (30%) complained about symptoms of nocturnal hypoventilation (daytime sleepiness), 13 (43%) had dyspnoea during physical strain. 7/27 (26%) patients presented abnormalities in the (i.e. FVC, FEV1) lung function tests (mean FVC 95,2% +/-20,2). 11/27 (41%) had a reduced force of the respiratory muscles (PImax 64,7 +/-25,3). Nocturnal respiratory disorders (in most cases slight) were found in 8/30 (27%) patients. In most cases both, pyridostigmine (25/30=83%) and immunosuppressants (18/30 =60%) were applied. Actual severity of disease as expressed by Besinger’s Score correlated with VKdiff (rho=0.58, p=0.002) and the concentration of the acetylcholine-receptor-antibodies (AchR-AK, p=0.04). The VKdiff itself correlated with AchR-AK concentration (rho=0.441, p=0.015). The HDS correlated with respiratory disturbances (p=0.03). A correlation between nocturnal respiratory disorders and the force of the respiratory muscles was not found. The presence of bulbar symptoms (p=0.035), higher age (p=0.004), a FVC4 (p=0.03) proved to increase or indicate the individuals risk for nocturnal respiratory disorders. Conclusions Respiratory disorders are common among treated myasthenic patients. Every case should be evaluated by a careful clinical examination and lung function assessment with measurement of maximum airway pressures. Where there is bulbar muscle involvement, patients are prone to developing lung and airway complications. Coexisting cardiopulmonary disease increases the strain on respiratory muscles. Such diseases therefore are risk factors for exhaustion of respiratory muscles, for nocturnal hypoventilation and apneas. If MG is adequately treated, nocturnal respiratory problems are rare. Individual treatment can be still improved by extended use of immunosuppressants and delayed release pyridostigmine.Hintergrund und Fragestellung Der Myasthenia gravis (MG) liegt eine Autoantikörper vermittelte postsynaptische Störung der neuromuskulären Übertragung zu Grunde. Akute Verschlechterungen der Erkrankung („myasthene Krisen“) geht mit einer Schwäche der Atemmuskulatur bis zur Beatmungspflicht einher. Die Behandlung der Erkrankung mit Kortikosteroiden, Immunsuppressiva (Azathioprin) und Acetylcholinesteraseinhibitoren hat die einst hohe Mortalität der Erkrankung erfreulich gesenkt. Ziel dieser Arbeit war, Häufigkeit und Ausmaß von Störungen der Atmung in einem unselektierten, behandelten Patientenkollektiv zu ermitteln. Weiterhin sollte der Zusammenhang von Atemstörungen mit der Erkrankungsschwere und dem Titer der Acetylcholinrezeptor­antikörper untersucht werden. Patienten und Methoden Untersucht wurden 30 Patienten (17 Frauen) mit einer gesicherten, generalisierten MG. Neben einer klinisch-neurologischen Beurteilung mit Quantifizierung der Symptomatik (Myasthenie- Score von K. Besinger) wurden Lungenfunktionsparameter (FVC im Liegen und Sitzen, FEV1) und Mundverschlussdrücke (PImax, PEmax) als Ausdruck der Kraft der Atemmuskulatur erhoben. Die nächtliche Atmung wurde mit einer ambulanten kardiorepiratorischen Polygrafie erfasst, einzelne Patienten wurden polysomnographisch untersucht. Lebensqualität und Behinderung im Alltag wurden quantifiziert (Barthel Index, Epworth Sleepiness Scale und Hamilton Depression Scale (HDS)). Ergebnisse Das mittlere Alter der Patienten betrug 52,5 (+/-18,5) Jahre, die mittlere Krankheitdauer 58 (+/-54) Monate, der mittlere Besinger-Score 5 (+/-3,71) Punkte. 20 Pat. befanden sich im Stadium 2b nach Ossermann, 18 waren thymektomiert worden. 7 (23%) hatten mindestens eine kardiopulmonale Begleiterkrankung. 9 Pat. (30%) beklagten Symptome einer nächtlichen Hypoventilation (Tagesmüdigkeit), 13 Belastungdyspnoe (43%). 7/27 (26%) wiesen Auffälligkeiten bei der klassischen Lungenfunktionsuntersuchung (FVC im Mittel 95,2% +/-20,2) auf. 11/27 (41%) hatten eine verminderte Atemmuskelkraft (PImax 64,7 +/-25,3). Eine (meist leichte) nächtliche Atemstörung ließ sich bei 8/30 (27%) nachweisen. In den meisten Fällen wurde sowohl mit Pyridostigmin (25/30=83%) als auch mit Immunsuppressiva (18/30=60%) behandelt. Die aktuelle Krankheitsausprägung (Besinger-Score) korrelierte mit der VKdiff (rho=0,58; p=0,002) und der Konzentration der Azetylcholinrezeptorantikörper (AchR-AK, p=0,04). Die VKdiff korrelierte ihrerseits mit der AchR-AK-Konzentration (rho= 0,441; p= 0,015). Die HDS korrelierte mit Atemstörungen (p=0,03). Ein Zusammenhang zwischen nächtlichen Atmungsstörungen und der Atemmuskelkraft fand sich nicht. Bulbäre Symptome (p=0,035), zunehmendes Alter (p=0,004), eine VK4 (p=0,03) erwiesen sich als Risiko erhöhend bzw. anzeigend für nächtliche Atemstörungen. Schlussfolgerung Atemstörungen sind auch bei therapierten Myastheniepatienten häufig. Neben einer sorgfältigen klinischen Evaluation sollte eine Lungenfunktionsuntersuchung mit Atemwegsdruckmessung jede ärztliche Kontrolle ergänzen. Besonders anfällig für Lungen- und Atemwegskomplika­tionen sind Patienten mit Beteiligung der bulbären Muskulatur. Kardiopulmonale Begleit­erkrankungen erhöhen die Atemarbeit. Diese Begleiterkrankungen stellen deshalb Risiko­faktoren für eine Erschöpfung der Atemmuskulatur, nächtliche Hypoventilation und Apnoen dar. Bei adäquater medikamentöser Behandlung der MG sind nächtliche Atemstörungen nur selten zu beobachten. Es bestehen jedoch oft beim einzelnen Patienten noch therapeutische Reserven beim Einsatz von Immunsuppressiva und von retardierten Pyridostigminpräparaten

Negative perfectionism increases the risk of fatigue following a period of stress

Cognitive-behavioural models of excessive fatigue suggest that people who believe that failure to meet high standards indicates unacceptability to others (a form of 'negative perfectionism') are at risk of fatigue after a period of illness or stress. The present study investigates this using a prospective design and possible mediating factors between such beliefs and fatigue were also investigated. Undergraduate students completed questionnaires at the beginning of the academic year (time 1; n = 436) and again following a time of academic pressure, 16 weeks later (time 2; n = 206). Participants were significantly more fatigued at time 2 than at time 1. Negative perfectionism was positively associated with all measures of fatigue and predicted subsequent levels of physical fatigue after controlling for time 1 fatigue. Time 1 negative perfectionism was not associated with time 2 perfectionist studying behaviours, distress about academic work or specific health behaviours, but was associated with time 2 depression. Results also indicated that time 2 depression may account for the relationship between baseline negative perfectionism and subsequent fatigue. This is the first prospective study to demonstrate a significant relationship between perfectionism and subsequent fatigue

Globally Optimal Catalysts: Computerbasierte Optimierung von abstrakten katalytischen Einbettungen für beliebige chemische Reaktionen

In the context of inverse design of molecules with desired optimal properties, the long-term goal of this Thesis is to develop a general framework which tackles the design of molecular systems for an optimal catalytic effect onto arbitrary chemical reactions. For any given reaction, an arrangement of an additional molecular framework around this reaction center is sought such that the energetic reaction barrier is lowered as much as possible. As necessary abstraction layer, the so-called globally optimal catalyst (GOCAT) model is introduced, and, furthermore, evolutionary algorithms (EAs) are harnessed as implemented in our global optimization suite for chemical problems, ogolem, which was highly extended to allow for these catalysis optimizations. Starting with a maximally reductionistic approach for studying the non-bonding interactions, electrostatic GOCATs are introduced that consist of arbitrary numbers, distributions and strengths of partial point charges around reacting molecules, mostly surrounding these on a common exposed surface. In the end, two reactions are studied in detail within the general topic of electrostatic catalysis. Some of the initially present model approximations are already sufficiently lifted, still-existing ones are critically assessed and further future extensions to the framework are discussed. Moreover, many method development matters are addressed: They range from optimal shared-memory parallelization, exemplified for global parameter optimization of the reactive force field, ReaxFF, via diversity control parameters for the EAs, applied to a cluster structure optimization problem, to EA operator benchmarks and optimizations of abstract electrostatics.Im Kontext von inversem Design von Molekülen mit optimalen Eigenschaften versucht die vorliegende Arbeit als Langzeitziel eine passende Plattform zu entwickeln, welche das generelle Design molekularer Systeme für einen optimalen Katalyseeffekt auf beliebige chemische Reaktionen projektiert. Für eine gegeben Reaktion soll eine hinzukommende chemische Umgebung komponiert werden, welche die Reaktionsenergiebarriere so weit wie möglich vermindert. Als notwendige Abstraktionsschicht wird das sogenannte Modell des globally optimal catalyst (GOCAT) eingeführt und außerdem kommen Evolutionäre Algorithmen (EAs) zur Anwendung, wie sie bereits in unserem Programmpaket zur Lösung allgemeiner globaler Optimierungsprobleme der Chemie, ogolem, bereitgestellt werden, welches jedoch deutlich für diese Katalyseoptimierungen ergänzt wurde. Angefangen in einem maximal-reduktionistischen Ansatz werden elektrostatische GOCATs erarbeitet, die aus einer beliebigen Anzahl, Verteilung und Stärke von Partialladungen bestehen und rund um die reagierenden Moleküle drapiert werden, meist auf einer gemeinsamen exponierten Oberfläche. Insgesamt werden zwei Reaktionen detailliert untersucht im generellen Kontext von elektrostatischer Katalyse. Einige eingangs vorhandene Modellannahmen werden bereits systematisch verbessert, noch vorhandene kritisch beleuchtet und künftige Erweiterungen auseinandergesetzt. Weiterhin werden unterschiedliche Methodenentwicklungsaspekte angesprochen: Diese reichen von verbesserter Parallelisierung in Mehrprozessorarchitekturen, beispielhaft gezeigt anhand einer globalen Parameteroptimierung des reaktiven Kraftfeldes ReaxFF, über Diversitätskontrollparameter des EAs, illustriert mittels eines Clusterstrukturoptimierungsproblems, bis hin zu EA-Operator-Testevaluationen und allgemeinen abstrakten Elektrostatikoptimierungen

Cognitive–behavioural therapy for adult attention-deficit hyperactivity disorder:a proof of concept randomised controlled trial

Objective: To investigate efficacy, patient acceptability and feasibility of formulation-based cognitive–behavioural therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD). NICE guidelines for adult ADHD recommend further research into psychological treatments. Method: Sixty participants with adult ADHD were randomly allocated to treatment as usual (TAU) vs. TAU plus up to 16 sessions of individual formulation-based CBT for ADHD. Results: Adding formulation-based CBT to TAU for ADHD significantly improved ADHD symptoms on the Barkley Current Symptoms Scale and scores on the Work and Social Adjustment Scale. Adjusted effect sizes (ES) were 1.31 and 0.82 respectively. There were also significant improvements on secondary outcomes including independently evaluated clinical global improvement, self-rated anxiety, depression, global distress and patient satisfaction (adjusted effect sizes 0.52–1.01). Conclusions: This is the first randomised controlled trial to provide preliminary evidence of efficacy and acceptability of individual formulation-based CBT for ADHD when added to TAU over TAU alone. This approach now needs to be tested in a larger multicentred randomised controlled trial.</p

Using endogenous saccades to characterize fatigue in multiple sclerosis

Purpose Multiple Sclerosis (MS) is likely to cause dysfunction of neural circuits between brain regions increasing brain working load or a subjective overestimation of such working load leading to fatigue symptoms. The aim of this study was to investigate if saccades can reveal the effect of fatigue in patients with MS. Methods Patients diagnosed with MS (EDSS<=3) and age matched controls were recruited. Eye movements were monitored using an infrared eyetracker. Each participant performed 40 trials in an endogenous generated saccade paradigm (valid and invalid trials). The fatigue severity scale (FSS) was used to assess the severity of fatigue. FSS scores were used to define two subgroups, the MS fatigue group (score above normal range) and the MS non-fatigue. Differences between groups were tested using linear mixed models. Results Thirty-one MS patients and equal number of controls participated in this study. FSS scores were above the normal range in 11 patients. Differences in saccade latency were found according to group (p<0.001) and trial validity (p=0.023). Differences were 16.9 ms, between MS fatigue and MS non-fatigue, 15.5 ms between MS fatigue and control. The mean difference between valid and invalid trials was 7.5 ms. Differences in saccade peak velocity were found according to group (p<0.001), the difference between MS fatigue and control was 22.3°/s and between MS fatigue and non-fatigue was 12.3°/s. Group was a statistically significant predictor for amplitude (p<0.001). FSS scores were correlated with peak velocity (p=0.028) and amplitude (p=0.019). Conclusion Consistent with the initial hypothesis, our study revealed altered saccade latency, peak velocity and amplitude in patients with fatigue symptoms. Eye movement testing can complement the standard inventories when investigating fatigue because they do not share similar limitations. Our findings contribute to the understanding of functional changes induced by MS and might be useful for clinical trials and treatment decisions.We would like to acknowledge that part of this work has been presented at 3rd International Porto Congress of Multiple Sclerosis, February 27–28, 2015, Porto, Portugal and ECEM 2015 | XVIII. European Conference on Eye Movements, August 16–21, 2015, Viena, Austria. We thank the Multiple Sclerosis Association “Todos com a Esclerose Multiple (TEM)” and the Clinical and Academic Centre (CAA-Hospital de Braga) for their support financial support and for providing facilities for data collection, respectively. We also acknowledge: i) Carla Sofia for recruiting all the MS participants and most of the controls, ii) Two anonymous reviewers for their opinion about an early version of this manuscript and iii) Liz Pearce for proofreading the manuscript. Vision Rehabilitation Lab. receives founding from Shamir Portugal and from grant PTDC/DTP-EPI/0412/2012, Fundação para a Ciência e a Tecnologia, co-financiado pelo FEDER através do COMPETE.info:eu-repo/semantics/publishedVersio

Fatigue in an adult ADHD population:a trans-diagnostic approach

ObjectivesTrans-diagnostic approaches suggest that key cognitive and behavioural processesmaintain symptoms across a wide range of mental health disorders. This study aims to1) investigate the prevalence of fatigue in adults with ADHD, 2) examine symptoms of ADHD in adults with Chronic Fatigue Syndrome (CFS) and 3) consider secondary clinical characteristics common to both disorder groups.MethodsMeasures of self-reported fatigue, ADHD symptomology (inattention, hyperactivity and impulsivity) were compared across groups of adults with ADHD (N = 243), CFS (N =86) and healthy controls (N = 211) using a between-subjects cross-sectional design. Groups were also compared on secondary clinical measures of functional impairment,mood, anxiety, sleep, self-efficacy and their beliefs about the acceptability of expressing emotions.ResultsThe ADHD group were significantly more fatigued than healthy controls and ADHD symptomology was significantly greater in the CFS group than healthy controls. ADHD and CFS groups did not differ significantly on measures of functional impairment, mood and self-efficacy. No significant differences were detected on measures of anxiety when items relating to physical restlessness were removed.ConclusionsAdults with ADHD experience greater fatigue than healthy controls. Adults with CFS and ADHD share many trans-diagnostic clinical characteristics, including difficulties with low mood, anxiety and reduced self-efficacy which impact upon their overall functioning. Further research is required to investigate extraneous factors mediating fatigue severity in these clinical groups.Practitioner Points*Fatigue is a common clinical feature of ADHD in adulthood*Evidenced-based interventions for CFS could be adapted to address fatigue in adults ADH