What physical exam techniques are useful to detect malingering?

No examination technique objectively proves malingering (strength of recommendation [SOR]: C, expert opinion). Waddell's signs are associated with poor treatment outcomes but cannot discriminate organic from nonorganic causes (SOR: B, systematic review of low-quality studies). Hoover's and the Abductor sign indicate nonorganic paralysis (SOR: C, small, lower-quality case-control studies)

Human Rights, the Cyprus Problem, and the Immovable Property Commission

AbstractThis article critically examines the role of the Immovable Property Commission, established in 2005 by the ‘Turkish Republic of Northern Cyprus’ under pressure from the European Court of Human Rights, to redress losses sustained by Greek Cypriots who fled south when the island was partitioned in the mid-1970s. While the Commission has been a modest success, proceedings have been lengthy, its decisions lack transparency, there have been difficulties with restitution and exchange, and the payment of compensation has often been delayed. Corporate ownership and encumbrances, such as mortgages, have also proved problematic. But, whether it contributes negatively or positively to full resolution of the Cyprus problem, or makes no contribution at all, remains to be seen.</jats:p

Associations Between Sociodemographic Characteristics and Perceptions of the Built Environment With the Frequency, Type, and Duration of Physical Activity Among Trail Users

Introduction Rail trails are elements of the built environment that support the Task Force on Community Preventive Services\u27 recommendation to create, or enhance access to, places for physical activity (PA). The purpose of this study was to examine the associations between sociodemographic characteristics and perceptions of the built environment with the frequency, type, and duration of PA among users of an urban, paved rail trail segment. Methods Interviewers conducted intercept surveys with 431 rail trail users and analyzed data by using logistic regression to estimate odds ratios between sociodemographic characteristics and perceptions of the built environment on the frequency, type, and duration of PA performed on the trail. Results Adults who used the trail in the cool months, traveled to the trail by a motorized vehicle, used the trail with others, and had some graduate school education visited the trail less often. Younger adults, men, whites, and those with some graduate school education were more likely to engage in vigorous activities on the trail. Adults who traveled to the trail by a motorized vehicle spent more time engaged in PA on the trail. Conclusion Our results suggest that the most frequent users of a rail trail for PA are those who use the trail alone and travel to the trail by bicycle or on foot. Trails are an aspect of the built environment that supports active lifestyles, and future studies should evaluate different types of trails among more diverse populations and locations

From Delhi to Mumbai, Apple Seeks a Bigger Slice of The Pie

From Delhi to Mumbai, Apple Seeks a Bigger Slice of The Pie in India: An International Marketing Case Study Mike Williams, Adam Pedraza, Taylor Greer, Brent Cassidy, Nick Hill, Chandler Burger, Steven Wehde, and Caleb Fortney Abstract Apple Inc., headquartered in the United States, is the world’s largest technology company with revenues of 265 billion as of 2018 (Johnson, 2012). Apple has been trying to compete in India’s smartphone market, the world’s fastest-growing and second-largest smartphone market globally, accounting for nearly 30 million purchases per quarter (Sheth, 2019). Despite its success in the U.S., Apple has not been able to overcome the unique challenges it faces in India. It faces entrenched Asian competitors like Xiaomi, Samsung, Vivo, and Oppo, who have a dominant share of the market. Indian consumers are very price sensitive and value deals (Lu, Yu, & Soman, 2016) which means Apple’s high-quality, premium pricing strategy only appeals to a small segment of affluent consumers. However, its competitors offer similar or even more localized features, at much lower prices. Indeed, over 75% of smartphones sold in India cost less than 250, whereas the iPhone is priced starting at $550 or higher (Cohan, 2018). Apple also faces other challenges in India, such as limited Internet connectivity, sourcing issues due to the government’s “Make in India” initiative, and limited consumer purchasing ability (Kashyap, 2017). This case study examines Apple’s overall marketing strategy in India in the context of the smartphone industry, competitors, consumer attitudes and government regulations. This case study will initiate discussions on how Apple must adapt its strategy to be able to succeed in India’s growing smartphone market. Keywords: Apple, iPhones, smartphones, India, mobile phones, emerging market, case study, international marketing Note: References available on request

Patterns of human exposure to malaria vectors in Zanzibar and implications for malaria elimination efforts

Zanzibar provides a good case study for malaria elimination. The islands have experienced a dramatic reduction in malaria burden since the introduction of effective vector control interventions and case management. Malaria prevalence has now been maintained below 1% for the past decade and the islands can feasibly aim for elimination.; To better understand factors that may contribute to remaining low-level malaria transmission in Zanzibar, layered human behavioural and entomological research was conducted between December 2016 and December 2017 in 135 randomly selected households across six administrative wards. The study included: (1) household surveys, (2) structured household observations of nighttime activity and sleeping patterns, and (3) paired indoor and outdoor mosquito collections. Entomological and human behavioural data were integrated to provide weighted estimates of exposure to vector bites, accounting for proportions of people indoors or outdoors, and protected by insecticide-treated nets (ITNs) each hour of the night.; Overall, 92% of female Anopheles mosquitoes were caught in the rainy season compared to 8% in the dry season and 72% were caught outdoors compared to 28% indoors. For individual ITN users, ITNs prevented an estimated two-thirds (66%) of exposure to vector bites and nearly three quarters (73%) of residual exposure was estimated to occur outdoors. Based on observed levels of ITN use in the study sites, the population-wide mean personal protection provided by ITNs was 42%.; This study identified gaps in malaria prevention in Zanzibar with results directly applicable for improving ongoing programme activities. While overall biting risk was low, the most notable finding was that current levels of ITN use are estimated to prevent less than half of exposure to malaria vector bites. Variation in ITN use across sites and seasons suggests that additional gains could be made through targeted social and behaviour change interventions. However, even for ITN users, gaps in protection remain, with a majority of exposure to vector bites occurring outdoors before going to sleep. Supplemental interventions targeting outdoor exposure to malaria vectors, and groups that may be at increased risk of exposure to malaria vectors, should be explored

Addressing Oral Health Disparities in Settings Without a Research-Intensive Dental School: Collaborative Strategies

Research suggests that oral health is linked to systemic health, and those with poor oral health are potentially at greater risk for important diseases, including cardiovascular disease, stroke, diabetes mellitus, and adverse pregnancy outcomes. Asians and Pacific Islanders (APIs) in Hawaii have high rates of many such diseases. Studies in children in Hawaii have revealed disparities in dental health; for example, API children have significantly higher rates of cavities than other groups. Hence, conducting further study is vital in adults, particularly APIs, to assess oral health and its correlation to overall health outcomes. Given the lack of a dental school and the lack of fluoridated water in the state, the University of Hawaii’s John A. Burns School of Medicine (JABSOM) has identified the need to assume a leadership role in creating effective community-based oral health research and treatment programs. With the support of the National Institute of Dental and Craniofacial Research, JABSOM fostered a collaborative relationship with the University of North Carolina at Chapel Hill School of Dentistry, a premiere research-intensive dental school, the Waimanalo Health Center, and the Hawaii State Department of Health. This partnership has worked together to implement a community-based approach to performing research designed to illuminate disparities and develop innovative strategies to promote oral health in Hawaii’s diverse populations. We hope that this collaborative, culturally competent approach may serve as a model for use in other settings without a research-intensive dental school

On Critchfield's proposal: student concerns and recommendations

This is the published version, reproduced here with the publisher's permission. This article is also available electronically from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359848/.No abstract available for this item