The Veterans Affairs Neuropathy Scale: A Reliable, Remote Polyneuropathy Exam.

Introduction: Polyneuropathy (PN) complaints are common, prompting many referrals for neurologic evaluation. To improve access of PN care in distant community clinics, we developed a telemedicine service (patient-clinician interactions using real-time videoconference technology) for PN. The primary goal of this study was to construct a remote exam for PN that is feasible, reliable, and concordant with in-person assessments for use in our tele-PN clinics. Methods: To construct the VA Neuropathy Scale (VANS), we searched the literature for existing, validated PN assessments. From these assessments, we selected a parsimonious set of exam elements based on literature-reported sensitivity and specificity of PN detection, with modifications as necessary for our teleneurology setting (i.e., a technician examination under the direction of a neurologist). We recruited 28 participants with varying degrees of PN to undergo VANS testing under 5 scenarios. The 5 scenarios differed by mode of VANS grading (in-person vs. telemedicine) and by the in-person examiner type (neurologist vs. technician) in telemedicine scenarios. We analyzed concordance between the VANS and a person's medical chart-derived PN status by modeling the receiver operating characteristic (ROC) curve. We analyzed reliability of the VANS by mixed effects regression and computing the intraclass correlation coefficient (ICC) of scores across the 5 scenarios. Results: The VA Neuropathy Scale (VANS) tests balance, gait, reflexes, foot inspection, vibration, and pinprick. Possible scores range from 0 to 50 (worst). From the ROC curve, a cutoff of >2 points on the VANS sets the sensitivity and specificity of detecting PN at 98 and 91%, respectively. There is a small (1.3 points) but statistically significant difference in VANS scoring between in-person and telemedicine grading scenarios. For telemedicine grading scenarios, there is no difference in VANS scores between neurologist and technician examinations. The ICC is 0.89 across all scenarios. Discussion: The VANS, informed by existing PN instruments, is a promising clinical assessment tool for diagnosing and monitoring the severity of PN in telemedicine settings. This pilot study indicates acceptable concordance and reliability of the VANS with in-person examinations

Tree growth and management in Ugandan agroforestry systems: effects of root pruning on tree growth and crop yield

Tree root pruning is a potential tool for managing below-ground competition when trees and crops are grown together in agroforestry systems. This study investigates its effects on growth and root distribution of Alnus acuminata (HB & K), Casuarina equisetifolia (L), Grevillea robusta (A. Cunn. ex R. Br), Maesopsis eminii (Engl.), and Markhamia lutea (Benth.) K. Schum. and on yield of adjacent crops in sub-humid Uganda. The trees were 3 years old at the commencement of the study, and most species were competing strongly with crops. Tree roots were pruned 41 months after planting by cutting and back-filling a trench to a depth of 0.3 m, at a distance of 0.3 m from the trees, on one side of the tree row. The trench was re-opened and roots re-cut at 50 and 62 months after planting. Effects on tree growth and root distribution were assessed over a 3 year period, and crop yield after the third root pruning at 62 months is reported here. Overall, root pruning had only a slight effect on tree growth: height growth was unaffected and diameter growth was reduced by only 4 %. A substantial amount of root re-growth was observed by 11 months after pruning. Tree species varied in the number and distribution of their roots, and Casuarina and Markhamia had considerably more roots per unit of trunk volume than the other tree species, especially in the surface soil layers. Casuarina and Maesopsis were the most competitive tree species with crops and Grevillea and Markhamia the least. Crop yield data provides strong evidence of the redistribution of root activity following root pruning, so that competition increased on the unpruned side of tree rows. Thus, one-sided root pruning will only be of use to farmers in a few circumstances. Key words: Alnus acuminata, Casuarina equisetifolia, Grevillea robusta, Maesopsis eminii, Markhamia lutea, root distribution, root functio

Teleneurology clinics for polyneuropathy: a pilot study.

INTRODUCTION:Polyneuropathy (PN) is a common condition with significant morbidity. We developed tele-polyneuropathy (tele-PN) clinics to improve access to neurology and increase guideline-concordant PN care. This article describes the mixed-methods evaluation of pilot tele-PN clinics at three community sites within the Greater Los Angeles VA Healthcare System. METHODS:For the first 25 patients (48 scheduled visits), we recorded the duration of the tele-PN visit and exam; the performance on three guideline-concordant care indicators (PN screening labs, opiate reduction, physical therapy for falls); and patient-satisfaction scores. We elicited comments about the tele-PN clinic from patients and the clinical team. We combined descriptive statistics with qualitative themes to determine the feasibility and acceptability of the tele-PN clinics. RESULTS:The average tele-PN encounter and exam times were 28.5 and 9.1 min, respectively. PN screening lab completion increased from 80 to 100%. Opiate freedom improved from 68 to 88%. Physical therapy for patients with recent falls increased from 58 to 100%. The tele-PN clinic was preferred for follow-up over in-person clinics in 86% of cases. Convenience was paramount to the clinic's success, saving an average of 231 min per patient in round-trip travel. The medical team's caring and collaborative spirit received high praise. While the clinic's efficiency was equal or superior to in-person care, the limited treatment options for PN and the small clinical exam space are areas for improvement. CONCLUSION:In this pilot, we were able to efficiently see and examine patients remotely, promote guideline-concordant PN care, and provide a high-satisfaction encounter

Non-rigid registration of breast surfaces using the laplace and diffusion equations

A semi-automated, non-rigid breast surface registration method is presented that involves solving the Laplace or diffusion equations over undeformed and deformed breast surfaces. The resulting potential energy fields and isocontours are used to establish surface correspondence. This novel surface-based method, which does not require intensity images, anatomical landmarks, or fiducials, is compared to a gold standard of thin-plate spline (TPS) interpolation. Realistic finite element simulations of breast compression and further testing against a tissue-mimicking phantom demonstrate that this method is capable of registering surfaces experiencing 6 - 36 mm compression to within a mean error of 0.5 - 5.7 mm

Belief in karma is associated with perceived (but not actual) trustworthiness

Believers of karma believe in ethical causation where good and bad outcomes can be traced to past moral and immoral acts. Karmic belief may have important interpersonal consequences. We investigated whether American Christians expect more trustworthiness from (and are more likely to trust) interaction partners who believe in karma. We conducted an incentivized study of the trust game where interaction partners had different beliefs in karma and God. Participants expected more trustworthiness from (and were more likely to trust) karma believers. Expectations did not match actual behavior: karmic belief was not associated with actual trustworthiness. These findings suggest that people may use others’ karmic belief as a cue to predict their trustworthiness but would err when doing so