Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies

OBJECTIVES: Most studies of carpal tunnel syndrome (CTS) incidence and prevalence among workers have been limited by small sample sizes or restricted to a small subset of jobs. We established a common CTS case definition and then pooled CTS prevalence and incidence data across six prospective studies of musculoskeletal outcomes to measure CTS frequency and allow better studies of etiology. METHODS: Six research groups collected prospective data at >50 workplaces including symptoms characteristic of CTS and electrodiagnostic studies (EDS) of the median and ulnar nerves across the dominant wrist. While study designs and the timing of data collection varied across groups, we were able to create a common CTS case definition incorporating both symptoms and EDS results from data that were collected in all studies. RESULTS: At the time of enrollment, 7.8% of 4321 subjects met our case definition and were considered prevalent cases of CTS. During 8833 person-years of follow-up, an additional 204 subjects met the CTS case definition for an overall incidence rate of 2.3 CTS cases per 100 person-years. CONCLUSIONS: Both prevalent and incident CTS were common in data pooled across multiple studies and sites. The large number of incident cases in this prospective study provides adequate power for future exposure– response analyses to identify work- and non-work-related risk factors for CTS. The prospective nature allows determination of the temporal relations necessary for causal inference

Assessing the benefits and usefulness of Schwartz Centre Rounds in Second-Year Medical Students using Clinical Educator-Facilitated Group Work Session: not just “A Facilitated Moan”!

Background An experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders. Schwartz rounds (SR) are an effective means to combat emotional stress and increasingly used in UK and USA hospitals. Recent studies show that the SR format may also provide benefits for medical students. This study aimed to investigate whether the guidance of SR in second year medical students provides the same benefits as to healthcare professionals. Methods SR assessment involved 83 second year MBChB students in facilitated groupwork sessions. Topics discussed were “change and resilience” and “duty of candour”. Students completed a Likert Scale questionnaire evaluating outcomes proffered by the Point of Care Foundation in collaboration with the Schwartz Foundation, with freeform feedback. Results There was an 86% completion rate with 25% providing written feedback. Participants were more likely to agree than disagree that SR were beneficial. SR effectiveness in enhancing students’ working relationship awareness and skills was strongly correlated with understanding the purpose of, and engagement with, the SR (P<0.001). Similarly, engagement with the SR was strongly correlated with self-reporting of enhanced patient-centredness (P < 0.001). Freeform feedback could be grouped into five themes that revolved around understanding of the SR and engagement with the process. Many positive comments regarded the SR as a forum not only to “learn experientially” but to so in a “safe environment”. Many negative comments stemmed from students not seeing any benefits of engagement with the SR, in that sharing experiences was “unbeneficial”, “empathy is inherent and not learnt”, or that sharing emotional problems is simply “moaning”. Conclusion SRs are an effective way of fostering empathy and understanding towards patients and colleagues. However, for the students to benefit fully from the SR it is necessary for them to engage and understand the process. Therefore, for the successful implementation of SR into pre-clinical medical education, it is important to help students realise that SR are not merely a “facilitated whinge”

Ergonomic evaluation of an alternative tool for cake decorating

Aim Cake decorating involves several hand intensive steps with high grip force during the application of icing. The purpose of this laboratory study was to evaluate forearm muscle activity, discomfort, productivity, and usability of an alternative tool for cake decorating compared to decorating with the traditional piping bag. Methods Participants (n&nbsp;=&nbsp;17) performed 2&nbsp;h of cake decorating tasks using the two tools. Subjective hand and arm fatigue, usability, upper extremity posture, and muscle activity from three forearm muscles were assessed for each tool. Outcome measures were evaluated using the Wilcoxon Signed Rank test and the paired t-test. Results Less fatigue was reported in the dominant hand (p&nbsp;=&nbsp;0.001), forearm (p&nbsp;=&nbsp;0.003) and shoulder (p&nbsp;=&nbsp;0.02) for the alternative tool when compared to the piping bag. Average median (APDF 50%) and peak (APDF 90%) muscle activity was significantly less for the alternative tool across all three forearm muscles. The alternative tool significantly reduced grip force, an important risk factor for distal upper extremity pain and disorders. Participants rated usability of the alternative tool superior for refill and comfort but the traditional method was rated better for accuracy, stability, positioning and control. Conclusions The alternative tool was associated with less dominant arm fatigue, muscle activity, and grip force when compared with the piping bag. However, the alternative tool did not receive the best overall usability rating due to problems with accuracy and overflow, especially with smaller decorating tips. Recommendations were made for addressing these problems with the alternative tool

New constraints on muon-neutrino to electron-neutrino transitions in MINOS

This paper reports results from a search for ν_μ → ν_e transitions by the MINOS experiment based on a 7×10^(20) protons-on-target exposure. Our observation of 54 candidate ν_e events in the far detector with a background of 49.1±7.0(stat)±2.7(syst) events predicted by the measurements in the near detector requires 2sin^2(2θ_(13))sin^2θ_(23)<0.12(0.20) at the 90% C.L. for the normal (inverted) mass hierarchy at δ_(CP)=0. The experiment sets the tightest limits to date on the value of θ_(13) for nearly all values of δ_(CP) for the normal neutrino mass hierarchy and maximal sin^2(2θ_(23))

Measurement of the underground atmospheric muon charge ratio using the MINOS Near Detector

The magnetized MINOS Near Detector, at a depth of 225 mwe, is used to measure the atmospheric muon charge ratio. The ratio of observed positive to negative atmospheric muon rates, using 301 days of data, is measured to be 1.266±0.001(stat)_(-0.014)^(+0.015)(syst). This measurement is consistent with previous results from other shallow underground detectors and is 0.108±0.019(stat+syst) lower than the measurement at the functionally identical MINOS Far Detector at a depth of 2070 mwe. This increase in charge ratio as a function of depth is consistent with an increase in the fraction of muons arising from kaon decay for increasing muon surface energie

Testing Lorentz Invariance and CPT Conservation with NuMI Neutrinos in the MINOS Near Detector

A search for a sidereal modulation in the MINOS near detector neutrino data was performed. If present, this signature could be a consequence of Lorentz and CPT violation as predicted by a class of extensions to the Standard Model. No evidence for a sidereal signal in the data set was found, implying that there is no significant change in neutrino propagation that depends on the direction of the neutrino beam in a sun-centered inertial frame. Upper limits on the magnitudes of the Lorentz and CPT violating terms in these extensions to the Standard Model lie between 0.01-1% of the maximum expected, assuming a suppression of these signatures by factor of $10^{-17}$.

Search for sterile neutrino mixing in the MINOS long-baseline experiment

A search for depletion of the combined flux of active neutrino species over a 735 km baseline is reported using neutral-current interaction data recorded by the MINOS detectors in the NuMI neutrino beam. Such a depletion is not expected according to conventional interpretations of neutrino oscillation data involving the three known neutrino flavors. A depletion would be a signature of oscillations or decay to postulated noninteracting sterile neutrinos, scenarios not ruled out by existing data. From an exposure of 3.18×10^(20) protons on target in which neutrinos of energies between ∼500  MeV and 120 GeV are produced predominantly as ν_μ, the visible energy spectrum of candidate neutral-current reactions in the MINOS far detector is reconstructed. Comparison of this spectrum to that inferred from a similarly selected near-detector sample shows that of the portion of the ν_μ flux observed to disappear in charged-current interaction data, the fraction that could be converting to a sterile state is less than 52% at 90% confidence level (C.L.). The hypothesis that active neutrinos mix with a single sterile neutrino via oscillations is tested by fitting the data to various models. In the particular four-neutrino models considered, the mixing angles θ_(24) and θ_(34) are constrained to be less than 11° and 56° at 90% C.L., respectively. The possibility that active neutrinos may decay to sterile neutrinos is also investigated. Pure neutrino decay without oscillations is ruled out at 5.4 standard deviations. For the scenario in which active neutrinos decay into sterile states concurrently with neutrino oscillations, a lower limit is established for the neutrino decay lifetime τ_3/m_3>2.1×10^(-12) s/eV at 90% C.L

Neutrino and Antineutrino Inclusive Charged-current Cross Section Measurements with the MINOS Near Detector

The energy dependence of the neutrino-iron and antineutrino-iron inclusive charged-current cross sections and their ratio have been measured using a high-statistics sample with the MINOS Near Detector exposed to the NuMI beam from the Main Injector at Fermilab. Neutrino and antineutrino fluxes were determined using a low hadronic energy subsample of charged-current events. We report measurements of neutrino-Fe (antineutrinoFe) cross section in the energy range 3-50 GeV (5-50 GeV) with precision of 2-8% (3-9%) and their ratio which is measured with precision 2-8%. The data set spans the region from low energy, where accurate measurements are sparse, up to the high-energy scaling region where the cross section is well understood.Comment: accepted by PR

A Study of Muon Neutrino Disappearance Using the Fermilab Main Injector Neutrino Beam

We report the results of a search for muon-neutrino disappearance by the Main Injector Neutrino Oscillation Search. The experiment uses two detectors separated by 734 km to observe a beam of neutrinos created by the Neutrinos at the Main Injector facility at Fermi National Accelerator Laboratory. The data were collected in the first 282 days of beam operations and correspond to an exposure of 1.27e20 protons on target. Based on measurements in the Near Detector, in the absence of neutrino oscillations we expected 336 +/- 14 muon-neutrino charged-current interactions at the Far Detector but observed 215. This deficit of events corresponds to a significance of 5.2 standard deviations. The deficit is energy dependent and is consistent with two-flavor neutrino oscillations according to delta m-squared = 2.74e-3 +0.44/-0.26e-3 eV^2 and sin^2(2 theta) > 0.87 at 68% confidence level.Comment: In submission to Phys. Rev.

First Direct Observation of Muon Antineutrino Disappearance

This Letter reports the first direct observation of muon antineutrino disappearance. The MINOS experiment has taken data with an accelerator beam optimized for ν̅ _μ production, accumulating an exposure of 1.71×10^(20) protons on target. In the Far Detector, 97 charged current ν̅ _μ events are observed. The no-oscillation hypothesis predicts 156 events and is excluded at 6.3σ. The best fit to oscillation yields |Δm̅ 2|= [3.36=_(-0.40)^(+0.46)(stat)±0.06(syst)]x10^(-3)eV^2,sin^2(2θ̅)=0.86 _(-0.12)^(+0.11)(stat)±0.01(syst). The MINOS ν̅ _μ and ν̅ _μ measurements are consistent at the 2.0% confidence level, assuming identical underlying oscillation parameters