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)

Data Recovery Excavations at the J. B. White Site (41MM341), Milam County, Texas

In summer and fall 2002, personnel with Prewitt and Associates, Inc., undertook data recovery excavations at prehistoric site 41MM341 for the Texas Department of Transportation, Environmental Affairs Division, to address the requirements of Section 106 of the National Historic Preservation Act and the Texas Antiquities Code. Site 41MM341 is in central Milam County, Texas, just southeast of the town of Cameron, on a low rise in the modern floodplain of the Little River. The excavations were necessitated by the planned replacement of the State Highway 36 bridge spanning the Little River floodplain, which will directly affect the archeological deposits at 41MM341. The site, which was tested in 2001 and determined eligible for listing in the National Register of Historic Places and designation as a State Archeological Landmark, is well preserved and contains stratified, multicomponent prehistoric materials encased in late Holocene alluvium. The data recovery excavations focused on broad exposure of the remains of a series of Late Prehistoric occupations dating from A.D. 800 or 900 to 1300, with more-limited sampling of a component dating to the A.D. 600– 700s. The excavations consisted of 4 backhoe trenches, 11 initial 1x1-m units, and 3 hand-excavated blocks covering 208 m2. The excavations identified a variety of cultural features and recovered the following: 303 shaped chipped stone tools; 494 expedient stone tools; 168 cores; 39,872 pieces of unmodified debitage; 30 stone tools modified by grinding or battering; 30 bone tools or modified bones; 4 ceramic sherds; 6,540 pieces of vertebrate faunal remains; more than 58.2 kg of invertebrate faunal remains; 1.6 kg of macrobotanical remains; 163.0 kg of burned and unburned rocks; and 30.0 kg of burned clay. The records generated by the excavations and later analyses and the artifacts and other materials retained for curation are housed at the Center for Archaeological Research, The University of Texas at San Antonio. Analysis of the data recovered indicates that 41MM341 was a campsite occupied perhaps mostly during the summer months by hunter-gatherers who took mussels and fish from the river and hunted a variety of game, especially deer, on the Little River floodplain and the surrounding uplands. They may have used botanical resources less, although they did consume hardwood nuts and wild onion and false garlic bulbs. One important activity performed at the site was manufacture of stone tools—mostly arrow points, knives, and expedient flake tools—using chert collected from gravel bars in the river. Many of these tools were used in the wide variety of procurement, processing, and manufacturing activities that typified daily life at 41MM341, but some appear to have been made because they would be needed later in the year after people left the site. One anticipated need was for trade with the Caddo Indians of east Texas. The people who lived at 41MM341 and other sites in the Little River valley interacted regularly with the Caddo, perhaps in trade relationships that helped cement cooperative alliances aimed at regulating competition among groups. Site 41MM341 contributes important information on this topic, which remains an interesting research issue for Native American groups who used the Blackland Prairie between central and east Texas during the Late Prehistoric period

Data Recovery Excavations ar the J.B. White Site (41MM341), Milam County, Texas

In summer and fall 2002, personnel with Prewitt and Associates, Inc., undertook data recovery excavations at prehistoric site 41MM341 for the Texas Department of Transportation, Environmental Affairs Division, to address the requirements of Section 106 of the National Historic Preservation Act and the Texas Antiquities Code. Site 41MM341 is in central Milam County, Texas, just southeast of the town of Cameron, on a low rise in the modern floodplain of the Little River. The excavations were necessitated by the planned replacement of the State Highway 36 bridge spanning the Little River floodplain, which will directly affect the archeological deposits at 41MM341. The site, which was tested in 2001 and determined eligible for listing in the National Register of Historic Places and designation as a State Archeological Landmark, is well preserved and contains stratified, multicomponent prehistoric materials encased in late Holocene alluvium. The data recovery excavations focused on broad exposure of the remains of a series of Late Prehistoric occupations dating from A.D. 800 or 900 to 1300, with more-limited sampling of a component dating to the A.D. 600– 700s. The excavations consisted of 4 backhoe trenches, 11 initial 1x1-m units, and 3 hand-excavated blocks covering 208 m2. The excavations identified a variety of cultural features and recovered the following: 303 shaped chipped stone tools; 494 expedient stone tools; 168 cores; 39,872 pieces of unmodified debitage; 30 stone tools modified by grinding or battering; 30 bone tools or modified bones; 4 ceramic sherds; 6,540 pieces of vertebrate faunal remains; more than 58.2 kg of invertebrate faunal remains; 1.6 kg of macrobotanical remains; 163.0 kg of burned and unburned rocks; and 30.0 kg of burned clay. The records generated by the excavations and later analyses and the artifacts and other materials retained for curation are housed at the Center for Archaeological Research, The University of Texas at San Antonio. Analysis of the data recovered indicates that 41MM341 was a campsite occupied perhaps mostly during the summer months by hunter-gatherers who took mussels and fish from the river and hunted a variety of game, especially deer, on the Little River floodplain and the surrounding uplands. They may have used botanical resources less, although they did consume hardwood nuts and wild onion and false garlic bulbs. One important activity performed at the site was manufacture of stone tools—mostly arrow points, knives, and expedient flake tools—using chert collected from gravel bars in the river. Many of these tools were used in the wide variety of procurement, processing, and manufacturing activities that typified daily life at 41MM341, but some appear to have been made because they would be needed later in the year after people left the site. One anticipated need was for trade with the Caddo Indians of east Texas. The people who lived at 41MM341 and other sites in the Little River valley interacted regularly with the Caddo, perhaps in trade relationships that helped cement cooperative alliances aimed at regulating competition among groups. Site 41MM341 contributes important information on this topic, which remains an interesting research issue for Native American groups who used the Blackland Prairie between central and east Texas during the Late Prehistoric period

Seven Archeological Surveys CSJs 0440-04-014, 1200-03-048, 0914-19-030, 0914-19-015, 0914-19-022, And 0914-26-006: RM 243, FM 973, CR 142, CR 119, and Spring Street: Burnet, Gillespie, Mason, And Travis Counties, Austin District

Personnel with Prewitt and Associates, Inc., completed seven archeological surveys in 2013 for the Texas Department of Transportation’s (TxDOT) Environmental Affairs Division in TxDOT’s Austin District under Texas Antiquities Permit No. 6541. The surveys were done to identify archeological sites that could be affected by bridge and road construction at the following six locations: Ranch-to-Market Road 243 at Bear Creek in Burnet County (CSJ 0440-04-014), Farm-to-Market Road 973 at the Colorado River in Travis County (CSJ 1200-03-048), County Road 142 at Palo Alto Creek (two locations) in Gillespie County (CSJs 0914-19-030 and 015), County Road 119 at the Pedernales River in Gillespie County (CSJ 0914-19-022), and Spring Street at Comanche Creek in Mason County (CSJ 0914-26-006). Two phases of survey were done in the Mason County project area. Fieldwork was performed by a team of one to three archeologists, with Damon Burden serving as project archeologist and Karl Kibler, Eloise Gadus, Aaron Norment, or John Dockall assisting as field archeologist or geoarcheologist. Ross C. Fields served as principal investigator. The surveys were done over about 30 work days (60 person days) in May–June and August– October 2013. Five of the locations have small horizontal Areas of Potential Effects, ranging from 0.6 to 3.3 acres and totaling 7.2 acres. The sixth, FM 973 at the Colorado River, is much larger at 43.9 acres. In addition to surface inspection, the surveys involved excavation of 34 backhoe trenches at all six locations and 46 shovel tests at five of them. In addition, 5 hand-dug test units were excavated at the Mason County location. Survey determined that three of the locations—RM 243 at Bear Creek, FM 973 at the Colorado River, and County Road 142 at Palo Alto Creek Location #2—do not contain archeological sites that could be impacted by the proposed projects. Two others—County Road 142 at Palo Alto Creek Location #1 and County Road 119 at the Pedernales River—were found to contain archeological sites (41GL476 and 41GL475, respectively), but the portions within the project areas have no capacity to contribute important information and thus are considered ineligible for listing in the National Register of Historic Places or designation as State Antiquities Landmarks. In contrast, 41MS99 found in the Spring Street at Comanche Creek project area is eligible for listing and designation. Artifacts were collected only during the two phases of survey in the Mason County project area; they will be curated, along with artifacts recovered during subsequent data recovery excavations at 41MS99, at the Texas Archeological Research Laboratory of the University of Texas at Austin. This also is the repository for all the records resulting from these surveys

Testing and Data Recovery Excavations at 41BU51, Burleson County, Texas

Prewitt and Associates, Inc. (PAI), conducted archeological testing and data recovery excavations at prehistoric site 41BU51 in Burleson County, Texas, for the Texas Department of Transportation, Environmental Affairs Division, in three phases of investigation. The first phase of testing, conducted in Spring 2003, resulted in the discovery of a single human burial as well as diagnostic artifacts ranging from the Archaic period through the Late Prehistoric period. A second phase of testing was conducted to search for additional burials in January 2004. This work resulted in the discovery of three additional burials and two isolated human bones. Finally, data recovery to remove the human remains was conducted in June 2007. This report describes all three phases of work. Analysis of the data recovered indicates that 41BU51 has a Late Archaic component that contributed many or even most of the lithic artifacts, most of the burned rocks and burned clay, some or all of the ceramic artifacts, and probably all of the human burials. Materials representing Late Prehistoric period occupations also are present, and the possibility exists that large numbers of the lithic artifacts in the upper 60 cm of the deposits were left by these occupations. A small number of artifacts predating the Late Archaic period were recovered, but these are older items recycled into younger deposits. Radiocarbon dates indicate that the Late Archaic and Late Prehistoric use of the site occurred over perhaps 3,200 to 3,600 years. The vertical distributions of the temporally sensitive artifacts and the radiocarbon dates, while hinting at some remnant time-related stratification of the cultural materials, make it clear that there has been much mixing of the deposits, presumably through faunal turbation and other forms of disturbance. With this degree of mixing, it is impossible to segregate the remains by time period or more-discrete components. Nonetheless, the archeological remains recovered indicate that 41BU51 was used intermittently over a long span of time, probably as a residential campsite, with some occupations during the Late Archaic period perhaps being for extended periods of time

Archeological Impact Evaluations and Surveys in the Texas Department of Transportation\u27s Atlanta, Dallas, Fort Worth, Paris, and Waco Districts, 1998-2000

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 five TxDOT districts—Atlanta, Dallas, Fort Worth, Paris, and Waco—in northeast, north-central, and central Texas. 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 31 August 1998 and concluded on 31 August 2000. During these two years, 41 work orders were completed. The 41 work orders consisted of 119 Impact Evaluations, 21 Surveys, 3 Surveys with Geoarcheological Evaluation, 1 work order for a quality control meeting with TxDOT, and 1 work order to produce this report. Combined, these work orders entailed efforts at 151 bridge or relief structure replacements, 14 projects involving primarily road widening or realignment (most with bridge replacements as well), and 1 project consisting of construction of an exit ramp. During completion of these work orders, 16 newly discovered or previously recorded archeological sites and 1 possible site were investigated. Fourteen of the Impact Evaluations resulted in a recommendation that an archeological survey be completed prior to construction. In 69 additional Impact Evaluations for which specific constructions were not available, survey was recommended if areas outside the existing right of way, or below the zone of disturbance within the existing right of way, will be disturbed substantially. The remaining 36 Impact Evaluations resulted in a recommendation that no survey be required based on the extent of disturbance and the limited potential for sites with good integrity. Three of the Surveys investigated sites that were recommended for testing to assess eligibility for listing in the National Register of Historic Places and designation as State Archeological Landmarks. On two other surveys, it was recommended that charcoal recovered be radiocarbon dated to aid in making the decision about whether testing is needed. The other 19 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

Archeological Impact Evaluations and Surveys in the Texas Department of Transportation\u27s Bryan, Corpus Christi, San Antonio, and Yoakum Districts, 2000-2001

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—Bryan, Corpus Christi, San Antonio, and Yoakum— in east-central and south-central Texas. 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 8 February 2000 and concluded on 8 February 2002. During these two years, 46 work orders were completed. The 46 work orders consisted of 71 Impact Evaluations, 20 Surveys, 5 Surveys with Geoarcheological Evaluations, and 1 work order to produce this report. Combined, these work orders entailed efforts at 58 bridge replacements, 16 projects involving primarily road widening or realignment, and 1 project consisting of creation of a wetland mitigation area. During completion of these work orders, five newly discovered or previously recorded archeological sites were investigated. Fifteen of the Impact Evaluations led to a recommendation that an archeological survey be completed before construction. The remaining 56 Impact Evaluations resulted in a recommendation that no survey be required based on the extent of disturbance and the limited potential for sites with good integrity. Three of the Surveys investigated sites that were recommended for testing to assess eligibility for listing in the National Register of Historic Places and designation as State Archeological Landmarks. The other 22 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

The Benefits of Volunteering, Volunteers’ Competencies, and their Integration into Business Education

During voluntary work, volunteers acquire valuable new knowledge and skills, but they often do not recognize these newly developed competencies, cannot apply them in further education, and fail to make others, including potential employers, aware of them. The classification and validation of these competencies can help to facilitate the transfer of volunteers’ competencies within the volunteer and labor markets; however, the required steps for validation of the acquired competencies are frequently complicated or unclear for volunteers. Additionally, accepted ways of validating are lacking in labor market. This paper starts by presenting the value and benefits of volunteering, especially in a business education context. Thereafter, the authors present a European partnership themselves. Second, the volunteers gain on the one hand professional competencies that were relevant to the labor market, like delegating tasks to other people. On the other hand, the volunteers mentioned social and process-oriented competencies, including communication and technical skills. Third, the researchers identified two major advantages of volunteering: volunteers learn networking and communicating, and volunteers experience opened new occupational fields. The authors presented in a fourth step opportunities to integrate volunteering into business education. Business education can therefore be a service learning or a social entrepreneurship education course.project—the Grundtvig Learning Partnership’s Volunteering Validation Highway (VVH). The partnership aimed to facilitate the validation and transfer of volunteers’ experience. The following paper discuss volunteering as important part of society and a business education approach integrating volunteering. To support the idea of integration, the authors present a study concerning volunteers’ competencies, the benefits of volunteering, and the usefulness in business education of competencies gained through volunteering. The study used data from a questionnaire and group discussions. Regarding different countries, the partners expected different understandings of volunteering; therefore, the researchers conducted mixednationality group discussions to develop a mutual understanding of volunteering. The researchers also developed a questionnaire according to the group discussion categories (inductive) and included both open-ended and multiple-choice questions. The results support the idea of integrating volunteering experiences in business education. First, the results showed benefits for society and for the volunteers themselves. Second, the volunteers gain on the one hand professional competencies that were relevant to the labor market, like delegating tasks to other people. On the other hand, the volunteers mentioned social and process-oriented competencies, including communication and technical skills. Third, the researchers identified two major advantages of volunteering: volunteers learn networking and communicating, and volunteers experience opened new occupational fields. The authors presented in a fourth step opportunities to integrate volunteering into business education. Business education can therefore be a service learning or a social entrepreneurship education course

Testing And Data Recovery Excavations At 41CV286, Coryell County, Texas

In 2008–2009, Prewitt and Associates, Inc., performed testing and data recovery excavations at prehistoric site 41CV286 in Coryell County for the Texas Department of Transportation, Environmental Affairs Division, under Texas Antiquities Permit No. 4955. The investigations were prompted by the planned replacement of the County Road 314 bridge over Station Creek (CSJ No. 0909-39-117) just upstream from where it flows into the Leon River and were done in compliance with Section 106 of the National Historic Preservation Act and the Antiquities Code of Texas. The work consisted of a ground-penetrating radar survey and excavation of 12 backhoe trenches, 14 test units, and 28 m2 in block units; manual excavations totaled 17.3 m3 . Combined, the testing and data recovery identified eight cultural features interpreted as remnants of four earth ovens, a hearth with associated discard pile, two incipient burned rock middens, and a rock discard pile. The excavations recovered 3 arrow points, 29 dart points, 46 nonprojectile bifaces and fragments, 14 unifaces and modified flake tools, 25 utilized flakes with no retouch modification, 3 cores, 13,923 pieces of debitage, 1,179 pieces of microdebitage from flotation samples, 7 battered or ground stone tools, 2,112 animal bones, 1 modified bone, 2,200 mussel shells, and 2 modified shells. Documented but not collected from both feature and nonfeature contexts were 730 kg of burned rocks. Five analytical units are defined for the site, with most of the cultural materials reflecting repeated use during the Late Archaic period as a campsite at which processing of plant foods using thermal rock features played a prominent role in site activities, along with processing of game and mussels and production and repair of stone tools. The artifacts recovered and records generated by the project are curated at the Texas Archeological Research Laboratory, The University of Texas at Austin

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