Diagnostic accuracy of the neurological upper limb examination II: Relation to symptoms of patterns of findings

Background: In a sample of patients in clinical occupational medicine we have demonstrated that an upper limb neurological examination can reliably identify patterns of findings suggesting upper limb focal neuropathies. This further study aimed at approaching the diagnostic accuracy of the examination. Methods: 82 limbs were semi-quantitatively assessed by two blinded examiners ( strength in 14 individual muscles, sensibility in 7 homonymous territories, and mechanosensitivity at 10 locations along nerves). Based on the topography of nerves and their muscular and sensory innervation we defined 10 neurological patterns each suggesting a localized nerve affliction. Information on complaints ( pain, weakness and/or numbness/tingling) collected by others served as a reference for comparison. The relation between the presence of pattern(s) and complaints was assessed by kappa-statistics. Sensitivity, specificity, and positive/negative predictive values were calculated, and pretest odds were compared to post-test probability. Results: The two examiners identified pattern( s) suggesting focal neuropathy in 34/36 out of 38 symptomatic limbs, respectively (kappa = 0.70/0.75), with agreement in 28 limbs. Out of 44 non-symptomatic limbs the examiners agreed on absence of any pattern in 38 limbs. With concordance between the examiners with regard to the presence or absence of any pattern, the sensitivity, specificity, positive and negative predictive values were 0.73, 0.86, 0.93 and 0.90, respectively. While the pre-test odds for a limb to be symptomatic amounted to 0.46 the post-test probability was 0.81. For each examiner the post-test probability was 0.87 and 0.88, respectively. Conclusion: The improved diagnostic confidence is an indication of one aspect of construct validity of the physical examination. For determination of clinical feasibility of the examination further studies are required, most importantly 1) studies of validity by means of comparison with additional references and 2) studies of the potential benefit that can be attained from its use

Survival of a wild ring-tailed lemur (Lemur catta) with abdominal trauma in an anthropogenically disturbed habitat

Soft tissue injuries are rarely reported in wild primates as these heal fast, are not obvious, and are rapidly scavenged or decompose after death. An adult female ring-tailed lemur (Lemur catta) was found to have a chronic gastrointestinal fistula in Beza Mahafaly Special Reserve, Madagascar. She was observed monthly for 13 months until her remains, which showed evidence of dog predation, were found. Until then, she was in good body condition, had gained weight from the previous year and was observed to exhibit normal behaviour and produce an infant. This report documents a wild strepsirrhine primate able to survive significant soft tissue injury in ananthropogenically disturbed habitat.RÉSUMÉIl est rare que des blessures dans les tissus mous soient signalés chez les primates vivant à l’état sauvage car ces blessures guérissent rapidement, sont moins visibles ou que les animaux eux-mêmes se décomposent ou sont rapidement mangés par d’autres animaux après leur mort. Une femelle adulte de lémur catta (Lemur catta) a été trouvée avec une fistule gastro-intestinale chronique. Elle avait été observée vivante tous les mois pendant 13 mois avant que nous ne trouvions son cadavre, qui montrait des signes de prédation par de chiens. Jusque - là, elle étaiten bonne condition physique, avait pris du poids par rapport à l’année précédente, montrait un comportement normal et avait donné naissance à un petit. Ce rapport documente une lésion grave des tissus mous sur un Prosimien qui a été capable de survivre dans un habitat perturbé par l’homme

Video in Survey Interviews: Effects on Data Quality and Respondent Experience

This study investigates the extent to which video technologies - now ubiquitous - might be useful for survey measurement. We compare respondents' performance and experience (n = 1,067) in live video-mediated interviews, a web survey in which prerecorded interview­ers read questions, and a conventional (textual) web survey. Compared to web survey re­spondents, those interviewed via live video were less likely to select the same response for all statements in a battery (non-differentiation) and reported higher satisfaction with their experience but provided more rounded numerical (presumably less thoughtful) answers and selected answers that were less sensitive (more socially desirable). This suggests the presence of a live interviewer, even if mediated, can keep respondents motivated and con­scientious but may introduce time pressure - a likely reason for increased rounding - and social presence - a likely reason for more socially desirable responding. Respondents "in­terviewed" by a prerecorded interviewer, rounded fewer numerical answers and responded more candidly than did those in the other modes, but engaged in non-differentiation more than did live video respondents, suggesting there are advantages and disadvantages for both video modes. Both live and prerecorded video seem potentially viable for use in pro­duction surveys and may be especially valuable when in-person interviews are not feasible

Phylogenetically Driven Sequencing of Extremely Halophilic Archaea Reveals Strategies for Static and Dynamic Osmo-response

© 2014. Organisms across the tree of life use a variety of mechanisms to respond to stress-inducing fluctuations in osmotic conditions. Cellular response mechanisms and phenotypes associated with osmoadaptation also play important roles in bacterial virulence, human health, agricultural production and many other biological systems. To improve understanding of osmoadaptive strategies, we have generated 59 high-quality draft genomes for the haloarchaea (a euryarchaeal clade whose members thrive in hypersaline environments and routinely experience drastic changes in environmental salinity) and analyzed these new genomes in combination with those from 21 previously sequenced haloarchaeal isolates. We propose a generalized model for haloarchaeal management of cytoplasmic osmolarity in response to osmotic shifts, where potassium accumulation and sodium expulsion during osmotic upshock are accomplished via secondary transport using the proton gradient as an energy source, and potassium loss during downshock is via a combination of secondary transport and non-specific ion loss through mechanosensitive channels. We also propose new mechanisms for magnesium and chloride accumulation. We describe the expansion and differentiation of haloarchaeal general transcription factor families, including two novel expansions of the TATA-binding protein family, and discuss their potential for enabling rapid adaptation to environmental fluxes. We challenge a recent high-profile proposal regarding the evolutionary origins of the haloarchaea by showing that inclusion of additional genomes significantly reduces support for a proposed large-scale horizontal gene transfer into the ancestral haloarchaeon from the bacterial domain. The combination of broad (17 genera) and deep (≥5 species in four genera) sampling of a phenotypically unified clade has enabled us to uncover both highly conserved and specialized features of osmoadaptation. Finally, we demonstrate the broad utility of such datasets, for metagenomics, improvements to automated gene annotation and investigations of evolutionary processes

Evaluation of coronary blood flow velocity during cardiac arrest with circulation maintained through mechanical chest compressions in a porcine model

<p>Abstract</p> <p>Background</p> <p>Mechanical chest compressions (CCs) have been shown capable of maintaining circulation in humans suffering cardiac arrest for extensive periods of time. Reports have documented a visually normalized coronary blood flow during angiography in such cases (TIMI III flow), but it has never been actually measured. Only indirect measurements of the coronary circulation during cardiac arrest with on-going mechanical CCs have been performed previously through measurement of the coronary perfusion pressure (CPP). In this study our aim was to correlate average peak coronary flow velocity (APV) to CPP during mechanical CCs.</p> <p>Methods</p> <p>In a closed chest porcine model, cardiac arrest was established through electrically induced ventricular fibrillation (VF) in eleven pigs. After one minute, mechanical chest compressions were initiated and then maintained for 10 minutes upon which the pigs were defibrillated. Measurements of coronary blood flow in the left anterior descending artery were made at baseline and during VF with a catheter based Doppler flow fire measuring APV. Furthermore measurements of central (thoracic) venous and arterial pressures were also made in order to calculate the theoretical CPP.</p> <p>Results</p> <p>Average peak coronary flow velocity was significantly higher compared to baseline during mechanical chests compressions and this was observed during the entire period of mechanical chest compressions (12 - 39% above baseline). The APV slowly declined during the 10 min period of mechanical chest compressions, but was still higher than baseline at the end of mechanical chest compressions. CPP was simultaneously maintained at > 20 mmHg during the 10 minute episode of cardiac arrest.</p> <p>Conclusion</p> <p>Our study showed good correlation between CPP and APV which was highly significant, during cardiac arrest with on-going mechanical CCs in a closed chest porcine model. In addition APV was even higher during mechanical CCs compared to baseline. Mechanical CCs can, at minimum, re-establish coronary blood flow in non-diseased coronary arteries during cardiac arrest.</p

Grothendieck ring of varieties, D- and L-equivalence, and families of quadrics

We discuss a conjecture saying that derived equivalence of smooth projective simply connected varieties implies that the difference of their classes in the Grothendieck ring of varieties is annihilated by a power of the affine line class. We support the conjecture with a number of known examples, and one new example. We consider a smooth complete intersection X of three quadrics in P5 and the corresponding double cover Y→P2 branched over a sextic curve. We show that as soon as the natural Brauer class on Y vanishes, so that X and Y are derived equivalent, the difference [X]−[Y] is annihilated by the affine line class

Fluoride Exposure in Michigan Schoolchildren

Recent trends in the prevalence of dental caries in children, as well as a possible increase in the prevalence of dental fluorosis, have prompted some researchers to suggest the reassessment of water fluoride concentration standards. Instead of reducing water fluoride concentrations, an alternative approach would be to limit the use of, or reduce the fluoride concentration of, dentifrices, mouthrinses, and supplements. Information about the use of these other sources of fluoride, however, is scarce. Using data from a 1987 survey of Michigan schoolchildren, exposure to selected fluoride sources as well as tooth brushing habits are described. Responses from questionnaires revealed that, overall, 98.5 percent of the children have used fluoride dentifrices, 27 percent have used topical fluoride rinses, 72.5 percent have had at least one exposure to professionally applied topical fluoride, and 27percent have used dietary fluoride supplements. Although the use of fluoride dietary supplements was appropriate for most children residing in fluoride-deficient Cadillac, the percentages of children in the other communities who have ingested these supplements suggest that these products are being prescribed improperly. Given the almost universal use of fluoride dentifrices at an early age, it may be time to investigate the use of reduced fluoride dentifrices for children. In addition, continuing efforts to decrease inappropriate dietary fluoride supplementation are required.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65672/1/j.1752-7325.1990.tb03552.x.pd

Fluorosis risk from early exposure to fluoride toothpaste

Swallowed fluoride toothpaste in the early years of life has been postulated to be a risk factor for fluorosis, but the epidemiological evidence is weakened by the fact that most of the relevant studies were done in developed countries where an individual is exposed to multiple sources of fluoride. Objectives: To quantify the risk of fluorosis from fluoride toothpaste in a population whose only potential source of fluoride was fluoride toothpaste. Methods: Case-control analyses were conducted to test the hypothesis that fluoride toothpaste use before the age of 6 years increased an individual's risk of fluorosis. Data came from a cross-sectional clinical dental examination of schoolchildren and a self-administered questionnaire to their parents. The study was conducted in Goa, India. The study group consisted of 1189 seventh grade children with a mean age of 12.2 years. Results: The prevalence of fluorosis was 12.9% using the TF index. Results of the crude, stratified, and logistic regression analyses showed that use of fluoride toothpaste before the age of 6 years was a risk indicator for fluorosis (OR 1.83, 95% CI 1.05–3.15). Among children with fluorosis, beginning brushing before the age of 2 years increased the severity of fluorosis significantly ( P < 0.001). Other factors associated with the use of fluoride toothpaste, such as eating or swallowing fluoride toothpaste and higher frequency of use, did not show a statistically significant increased risk for prevalence or severity of fluorosis. Conclusions: Fluoride toothpaste use before the age of 6 years is a risk indicator for fluorosis in this study population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75437/1/j.1600-0528.1998.tb01957.x.pd