Simultaneous bilateral or unilateral carpal tunnel release? A prospective cohort study of early outcomes and limitations

BACKGROUND: Over 60% of patients with carpal tunnel syndrome present with symptoms and findings of nerve compression in both hands. Our goal was to compare patient-rated difficulties in performing activities of daily living in the early postoperative period between those undergoing bilateral carpal tunnel release and those undergoing unilateral carpal tunnel release. METHODS: This prospective cohort study enrolled consecutive patients with bilateral carpal tunnel syndrome undergoing bilateral carpal tunnel release (n = 47) or unilateral carpal tunnel release (n = 41). Patient function and disease severity were measured by an abbreviated form of the Disabilities of the Arm, Shoulder and Hand questionnaire, QuickDASH, and the Boston Carpal Tunnel Questionnaire at baseline, at postoperative visit 1 at a mean time (and standard deviation) of 10 ± 3 days, and at postoperative visit 2 at a mean time (and standard deviation) of 30 ± 6 days. Patients rated their difficulty in completing fifteen activities of daily living each day for the first postoperative week. Patients reported the factors that influenced their choice of surgery. RESULTS: There was no difference in baseline function or disease severity between the two groups with regard to QuickDASH and the Boston Carpal Tunnel Questionnaire. Patients in both groups improved after carpal tunnel release with no difference between groups either at postoperative visit 1 for QuickDASH (p = 0.97) and the Boston Carpal Tunnel Questionnaire (p = 0.86) or at postoperative visit 2 for QuickDASH (p = 0.43) and the Boston Carpal Tunnel Questionnaire (p = 0.34). Patients undergoing bilateral carpal tunnel release had more difficulty only during postoperative days 1 to 2 in opening jars (p = 0.03), cooking (p = 0.008), and doing household chores (p = 0.02). Patients in the two groups did not differ (p > 0.05) in their abilities to perform activities of daily living necessary for personal hygiene or independence on any day during the first seven days following surgery with regard to using the bathroom, bathing, dressing, or eating. Although the most common reason why patients chose bilateral carpal tunnel release was to avoid two surgical procedures (42%), the most common reason why patients chose unilateral carpal tunnel release was concern for self-care (36%). CONCLUSIONS: Patients with bilateral carpal tunnel syndrome can anticipate more severe functional impairment during the first few postoperative days with bilateral carpal tunnel release compared with unilateral carpal tunnel release, but limitations beyond postoperative day 2 or 3 are similar for bilateral and unilateral carpal tunnel release. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence

Lorentz-Abraham-Dirac vs Landau-Lifshitz radiation friction force in the ultrarelativistic electron interaction with electromagnetic wave (exact solutions)

When the parameters of electron - extreme power laser interaction enter the regime of dominated radiation reaction, the electron dynamics changes qualitatively. The adequate theoretical description of this regime becomes crutially important with the use of the radiation friction force either in the Lorentz-Abraham-Dirac form, which possess unphysical runaway solutions, or in the Landau-Lifshitz form, which is a perturbation valid for relatively low electromagnetic wave amplitude. The goal of the present paper is to find the limits of the Landau-Lifshitz radiation force applicability in terms of the electromagnetic wave amplitude and frequency. For this a class of the exact solutions to the nonlinear problems of charged particle motion in the time-varying electromagnetic field is used.Comment: 14 pages, 5 figure

A Statistical Inference Method for Interpreting the CLASP Observations

On 3rd September 2015, the Chromospheric Lyman-Alpha SpectroPolarimeter (CLASP) successfully measured the linear polarization produced by scattering processes in the hydrogen Lyman-$\alpha$ line of the solar disk radiation, revealing conspicuous spatial variations in the $Q/I$ and $U/I$ signals. Via the Hanle effect the line-center $Q/I$ and $U/I$ amplitudes encode information on the magnetic field of the chromosphere-corona transition region (TR), but they are also sensitive to the three-dimensional structure of this corrugated interface region. With the help of a simple line formation model, here we propose a statistical inference method for interpreting the Lyman-$\alpha$ line-center polarization observed by CLASP.Comment: Accepted for publication in The Astrophysical Journa

Detecting radiation reaction at moderate laser intensities.

We propose a new method of detecting radiation reaction effects in the motion of particles subjected to laser pulses of moderate intensity and long duration. The effect becomes sizable for particles that gain almost no energy through the interaction with the laser pulse. Hence, there are regions of parameter space in which radiation reaction is actually the dominant influence on charged particle motion

Multi-level voting and party competition in vertically simultaneous elections:the case of Ukraine

Vertically simultaneous elections to state-wide and regional legislatures provide us with a naturally occurring experiment in which to examine regionalism and multi-level voting. We examine the 2006 vertically and horizontally simultaneous state-wide and regional elections in Ukraine to determine how the internal dynamics of regionalism within a state account for the dissimilarity of voting behaviour across electoral levels. Drawing on the party competition literature we demonstrate that variations in both supply (parties) and demand (voters) produce considerable dissimilarity between regional and state results, with lower levels of consolidation and greater fractionalisation at the regional level. We show that political cleavages operate differently across levels, that regional distinctiveness rather than regional authority better predicts first order-ness in regional elections and that voters display varying tolerance for polarisation at the regional and state leve

Autocracy-Sustaining Versus Democratic Federalism:Explaining the Divergent Trajectories of Territorial Politics in Russia and Western Europe

This article provides a comparative assessment of territorial politics in Russia and Western Europe. The consolidation or deepening of regional autonomy in Western Europe contrasts with the transformation of Russia from a segmented and highly centrifugal state into a centralized authoritarian state in the course of just two decades. The consolidation of territorial politics in Western Europe is linked to the presence of endogenous safeguards that are built into their territorial constitutional designs and most importantly to the dynamics that emanate from multi-level party competition in the context of a liberal and multi-level democracy. In contrast, in Russia, neither endogenous safeguards nor multi-level party democracy play an important role in explaining the dynamics of Russian federalism, but who controls key state resources instead. We argue that under Putin power dependencies between the Russian center and the regions are strongest where regional democracy is at its weakest, thus producing ‘autocracy-sustaining’ instead of a democratic federation. By studying the relationship between federalism and democracy in cases where both concepts are mutually reinforcing (as in Western Europe) with the critical case of Russia where they are not, we question the widely held view that democracy is a necessary pre-condition for federalism.Peer reviewe

Intermittent control models of human standing: similarities and differences

Two architectures of intermittent control are compared and contrasted in the context of the single inverted pendulum model often used for describing standing in humans. The architectures are similar insofar as they use periods of open-loop control punctuated by switching events when crossing a switching surface to keep the system state trajectories close to trajectories leading to equilibrium. The architectures differ in two significant ways. Firstly, in one case, the open-loop control trajectory is generated by a system-matched hold, and in the other case, the open-loop control signal is zero. Secondly, prediction is used in one case but not the other. The former difference is examined in this paper. The zero control alternative leads to periodic oscillations associated with limit cycles; whereas the system-matched control alternative gives trajectories (including homoclinic orbits) which contain the equilibrium point and do not have oscillatory behaviour. Despite this difference in behaviour, it is further shown that behaviour can appear similar when either the system is perturbed by additive noise or the system-matched trajectory generation is perturbed. The purpose of the research is to come to a common approach for understanding the theoretical properties of the two alternatives with the twin aims of choosing which provides the best explanation of current experimental data (which may not, by itself, distinguish beween the two alternatives) and suggesting future experiments to distinguish between the two alternatives

Beam dynamics for the sc cw heavy ion linac at GSI

For future experiments with heavy ions near the coulomb barrier within the SHE (super-heavy elements) research project a multi-stage R&D program of GSI, HIM and IAP is currently in progress. It aims at developing a superconducting (sc) continuous wave (cw) LINAC with multiple CH cavities as key components downstream the High Charge Injector (HLI) at GSI. The beam dynamics concept is based on EQUUS (equidistant multigap structure) constant-beta cavities. Advantages of its periodicity are a high simulation accuracy, easy manufacturing and tuning with minimized costs as well as a straightforward energy variation. The next milestone will be a full performance beam test of the first LINAC section, comprising two solenoids and a 15-gap CH cavity inside a cryostat (Demonstrator)