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)

Archeological Impact Evaluations and Surveys in the Texas Department of Transportation\u27s Corpus Christi, Laredo, Pharr, and San Antonio Districts 2003-2005

This document constitutes the final report of work done by Prewitt and Associates, Inc. (PAI), under a contract from the Texas Department of Transportation (TxDOT) to provide archeological services in four TxDOT districts—Corpus Christi, Laredo, Pharr, and San Antonio. Under this contract, PAI completed Impact Evaluations and Surveys to assist TxDOT in meeting the requirements of their Memorandum of Understanding with the Texas Historical Commission and a Programmatic Agreement between the Advisory Council on Historic Preservation, the Federal Highway Administration, the Texas Historical Commission, and TxDOT. The contract began on March 17, 2003, and the last work authorization was issued on February 17, 2005. During those two years, fieldwork was done under 33 work authorizations. The 33 work authorizations consisted of 53 Impact Evaluations, 33 Surveys, and 2 Surveys with Geoarcheological Evaluation. Combined, these work authorizations entailed efforts at 47 bridge replacements, 4 bridge rehabilitation projects, 2 locations where new bridges will be built, 20 road rehabilitation or widening projects (many also involving bridge replacements or upgrades), 1 interstate highway rest area replacement, 3 drainage improvement projects, 2 curve realignment projects, 3 projects involving construction of new roads, 1 project involving construction of a railroad grade separation, 1 pedestrian bridge construction project, 1 project involving construction of a water taxi landing, 1 project involving construction of a hike-and-bike trail, 1 project involving modification of a highway interchange, and 1 project involving documentation of an archeological site disturbed by placement of a buried utility line. During completion of these work authorizations, 26 newly discovered or previously recorded archeological sites were investigated, although in the case of 9 previously recorded sites, no archeological remains were observed in the areas that will be impacted by the proposed Transportation Activities. Three of the Impact Evaluations led to recommendations that survey could be needed before construction, in some cases depending on whether new right of way would be required. The other 50 Impact Evaluations resulted in recommendations that no survey be required before construction based on the limited potential for sites with good integrity. Thirteen of the Surveys investigated a total of 3 newly recorded and 12 previously recorded sites. Of these 15 sites, 1 was considered eligible for listing in the National Register of Historic Places and designation as a State Archeological Landmark, and 1 was recommended as needing testing to assess eligibility. The other 33 Surveys either did not find any archeological sites, or they investigated sites that could be assessed as ineligible for National Register listing and State Archeological Landmark designation using the survey data. The records and artifacts generated by the project are curated at the Texas Archeological Research Laboratory

Archeological Impact Evaluations and Surveys in the Texas Department of Transportation\u27s Abilene, Austin, Brownwood, Bryan, Fort Worth, Waco, and Yoakum Districts, 2001-2003

This document constitutes the final report of work done by Prewitt and Associates, Inc. (PAI), under a contract from the Texas Department of Transportation (TxDOT) to provide archeological services in seven TxDOT districts—Abilene, Austin, Brownwood, Bryan, Fort Worth, Waco, and Yoakum. Under this contract, PAI completed Impact Evaluations and Surveys to assist TxDOT in meeting the requirements of their Memorandum of Understanding with the Texas Historical Commission and a Programmatic Agreement among the Advisory Council on Historic Preservation, the Federal Highway Administration, the Texas Historical Commission, and TxDOT. The contract began on 21 September 2001, and the last work authorization was issued on 15 September 2003. During those two years, fieldwork was done under 96 work authorizations. The 97 work authorizations consisted of 94 Impact Evaluations, 74 Surveys, and 14 Surveys with Geoarcheological Evaluation. Combined, these work authorizations entailed efforts at 128 bridge replacements, 40 road realignments or widening projects (many also involving bridge replacements), 5 new road construction projects, 4 hike-and-bike trail construction projects, 4 rest area construction projects, 3 projects involving upgrades to 9 existing bridges or culverts, 2 projects where new borrow pits are planned, 2 projects involving relocation of historic bridges to public parks, 1 project involving construction of 2 new bridges, 1 project involving replacement of an interstate highway interchange, and 1 project involving establishment of a wetland mitigation area. During completion of these work authorizations, 43 newly discovered or previously recorded archeological sites were investigated, although in the case of 14 previously recorded sites, no archeological remains were observed in the areas that will be affected by the proposed Transportation Activities. Twenty-three of the Impact Evaluations led to recommendations that survey could be needed before construction, in some cases depending on whether new right of way would be required. Based on the limited potential for sites with good integrity, the other 71 Impact Evaluations resulted in recommendations that no survey be required before construction. Twenty-two of the Surveys investigated a total of 17 newly recorded and 9 previously recorded sites. Of these 26 sites, 6 were recommended for testing to assess eligibility for listing in the National Register of Historic Places and designation as State Archeological Landmarks. The other 82 Surveys either did not find any archeological sites or investigated sites that could be assessed as ineligible for National Register listing and State Archeological Landmark designation using the survey data. All artifacts collected and records generated by projects done under this contract are curated at the Texas Archeological Research Laboratory (TARL), The University of Texas at Austin. Artifacts were collected from four sites. Those from 41GM3 are from state-owned lands and thus are curated in a held-in-trust status at TARL. The artifacts from 41BU51, 41BU54, and 41LE325 are from private lands and are curated in a non-held-in-trust status

Archeological Impact Evaluations and Surveys in the Texas Department of Transportation\u27s Abilene, Brownwood, Fort Worth, and Waco Districts, 2003-2006

This document constitutes the final report of work done by Prewitt and Associates, Inc. (PAI), under a contract from the Texas Department of Transportation (TxDOT) to provide archeological services in four TxDOT districts—Abilene, Brownwood, Fort Worth, and Waco. Under this contract, PAI completed Impact Evaluations and Surveys to assist TxDOT in meeting the requirements of their Memorandum of Understanding with the Texas Historical Commission and a Programmatic Agreement between the Advisory Council on Historic Preservation, the Federal Highway Administration, the Texas Historical Commission, and TxDOT. The contract began on 26 September 2003. A total of 77 projects were conducted. The 77 projects consisted of 25 Impact Evaluations and 52 Surveys. Combined, these entailed efforts at 52 bridge replacements, 14 road realignment or widening projects (many also involving bridge replacements), 1 new road construction project, 1 hike-and-bike trail construction project, 5 projects involving upgrading or replacing existing culverts, 1 project involving construction of drainage improvements, 2 unspecified road maintenance or improvement projects, and 1 project involving replacement of an interstate highway interchange. Of the 25 Impact Evaluations done, 8 led to recommendations that survey could be needed before construction. In 4 cases, the need for survey depended on whether new right of way would be acquired, which was unknown when the Impact Evaluations were done. The other 17 Impact Evaluations resulted in recommendations that no survey be required before construction based on the limited potential for sites with good integrity. Of the 52 Surveys done under this contract, 9 investigated six newly recorded and four previously recorded sites; eight of the sites are prehistoric, and two are of historic age. Four prehistoric sites were recommended for testing to assess eligibility for listing in the National Register of Historic Places and designation as State Archeological Landmarks, and one historic site was recommended for archival and oral history research. The other 43 Surveys did not find any archeological sites. All artifacts collected and records generated by projects done under this contract are curated at the Texas Archeological Research Laboratory (TARL), The University of Texas at Austin. Artifacts were collected from five sites (41BQ285, 41CV1636, 41HM53, 41LT307, and 41SV4). Those from 41HM53 and 41SV4 are from State-owned lands and thus are curated in a held-in-trust status at TARL. The artifacts from 41BQ285, 41CV1636, and 41LT307 are from private lands and are curated in a non-held-in-trust status

Spider Silk Constructs Enhance Axonal Regeneration and Remyelination in Long Nerve Defects in Sheep

BACKGROUND: Surgical reapposition of peripheral nerve results in some axonal regeneration and functional recovery, but the clinical outcome in long distance nerve defects is disappointing and research continues to utilize further interventional approaches to optimize functional recovery. We describe the use of nerve constructs consisting of decellularized vein grafts filled with spider silk fibers as a guiding material to bridge a 6.0 cm tibial nerve defect in adult sheep. METHODOLOGY/PRINCIPAL FINDINGS: The nerve constructs were compared to autologous nerve grafts. Regeneration was evaluated for clinical, electrophysiological and histological outcome. Electrophysiological recordings were obtained at 6 months and 10 months post surgery in each group. Ten months later, the nerves were removed and prepared for immunostaining, electrophysiological and electron microscopy. Immunostaining for sodium channel (NaV 1.6) was used to define nodes of Ranvier on regenerated axons in combination with anti-S100 and neurofilament. Anti-S100 was used to identify Schwann cells. Axons regenerated through the constructs and were myelinated indicating migration of Schwann cells into the constructs. Nodes of Ranvier between myelin segments were observed and identified by intense sodium channel (NaV 1.6) staining on the regenerated axons. There was no significant difference in electrophysiological results between control autologous experimental and construct implantation indicating that our construct are an effective alternative to autologous nerve transplantation. CONCLUSIONS/SIGNIFICANCE: This study demonstrates that spider silk enhances Schwann cell migration, axonal regrowth and remyelination including electrophysiological recovery in a long-distance peripheral nerve gap model resulting in functional recovery. This improvement in nerve regeneration could have significant clinical implications for reconstructive nerve surgery

Dopamine neurons modulate neural encoding and expression of depression-related behaviour

Major depression is characterized by diverse debilitating symptoms that include hopelessness and anhedonia1. Dopamine neurons involved in reward and motivation are among many neural populations that have been hypothesized to be relevant, and certain antidepressant treatments, including medications and brain stimulation therapies, can influence the complex dopamine system. Until now it has not been possible to test this hypothesis directly, even in animal models, as existing therapeutic interventions are unable to specifically target dopamine neurons. Here we investigated directly the causal contributions of defined dopamine neurons to multidimensional depression-like phenotypes induced by chronic mild stress, by integrating behavioural, pharmacological, optogenetic and electrophysiological methods in freely moving rodents. We found that bidirectional control (inhibition or excitation) of specified midbrain dopamine neurons immediately and bidirectionally modulates (induces or relieves) multiple independent depression symptoms caused by chronic stress. By probing the circuit implementation of these effects, we observed that optogenetic recruitment of these dopamine neurons potently alters the neural encoding of depression-related behaviours in the downstream nucleus accumbens of freely moving rodents, suggesting that processes affecting depression symptoms may involve alterations in the neural encoding of action in limbic circuitry

All-sky Medium Energy Gamma-ray Observatory: Exploring the Extreme Multimessenger Universe

The All-sky Medium Energy Gamma-ray Observatory (AMEGO) is a probe class mission concept that will provide essential contributions to multimessenger astrophysics in the late 2020s and beyond. AMEGO combines high sensitivity in the 200 keV to 10 GeV energy range with a wide field of view, good spectral resolution, and polarization sensitivity. Therefore, AMEGO is key in the study of multimessenger astrophysical objects that have unique signatures in the gamma-ray regime, such as neutron star mergers, supernovae, and flaring active galactic nuclei. The order-of-magnitude improvement compared to previous MeV missions also enables discoveries of a wide range of phenomena whose energy output peaks in the relatively unexplored medium-energy gamma-ray band

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead