Clinical course, costs and predictive factors for response to treatment in carpal tunnel syndrome: The PALMS study protocol

Background Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb and a significant contributor to hand functional impairment and disability. Effective treatment options include conservative and surgical interventions, however it is not possible at present to predict the outcome of treatment. The primary aim of this study is to identify which baseline clinical factors predict a good outcome from conservative treatment (by injection) or surgery in patients diagnosed with carpal tunnel syndrome. Secondary aims are to describe the clinical course and progression of CTS, and to describe and predict the UK cost of CTS to the individual, National Health Service (NHS) and society over a two year period. Methods/Design In this prospective observational cohort study patients presenting with clinical signs and symptoms typical of CTS and in whom the diagnosis is confirmed by nerve conduction studies are invited to participate. Data on putative predictive factors are collected at baseline and follow-up through patient questionnaires and include standardised measures of symptom severity, hand function, psychological and physical health, comorbidity and quality of life. Resource use and cost over the 2 year period such as prescribed medications, NHS and private healthcare contacts are also collected through patient self-report at 6, 12, 18 and 24 months. The primary outcome used to classify treatment success or failures will be a 5-point global assessment of change. Secondary outcomes include changes in clinical symptoms, functioning, psychological health, quality of life and resource use. A multivariable model of factors which predict outcome and cost will be developed. Discussion This prospective cohort study will provide important data on the clinical course and UK costs of CTS over a two-year period and begin to identify predictive factors for treatment success from conservative and surgical interventions

An MCMC approach to extracting the global 21-cm signal during the cosmic dawn from sky-averaged radio observations

Efforts are being made to observe the 21-cm signal from the 'cosmic dawn' using sky-averaged observations with individual radio dipoles. In this paper, we develop a model of the observations accounting for the 21-cm signal, foregrounds, and several major instrumental effects. Given this model, we apply Markov Chain Monte Carlo techniques to demonstrate the ability of these instruments to separate the 21-cm signal from foregrounds and quantify their ability to constrain properties of the first galaxies. For concreteness, we investigate observations between 40 and 120 MHz with the proposed DARE mission in lunar orbit, showing its potential for science return.Comment: 16 pages, 14 figures; accepted by MNRAS; minor edits to match accepted versio

Observing Neutral Hydrogen Above Redshift 6: The "Global" Perspective

Above redshift 6, the dominant source of neutral hydrogen in the Universe shifts from localized clumps in and around galaxies and filaments to a pervasive, diffuse component of the intergalactic medium (IGM). This transition tracks the global neutral fraction of hydrogen in the IGM and can be studied, in principle, through the redshifted 21 cm hyperfine transition line. During the last half of the reionization epoch, the mean (global) brightness temperature of the redshifted 21 cm emission is proportional to the neutral fraction, but at earlier times (10 < z < 25), the mean brightness temperature should probe the spin temperature of neutral hydrogen in the IGM. Measuring the (of order 10 mK) mean brightness temperature of the redshifted 21 cm line as a function of frequency (and hence redshift) would chart the early evolution of galaxies through the heating and ionizing of the IGM by their stellar populations. Experiments are already underway to accomplish this task or, at least, provide basic constraints on the evolution of the mean brightness temperature. We provide a brief overview of one of these projects, the Experiment to the Detect the Global EOR Signature (EDGES), and discuss prospects for future results.Comment: From AIP Conference Proceedings, Volume 1035, 2008, "The Evolution of Galaxies through the Neutral Hydrogen Window". 3 page

Fracture incidence after liver transplantation: results of a 10-year audit

Background: High rates of fracture following liver transplantation were reported in earlier years, but the impact of subsequent changes in immune suppression and the introduction of bone-protective therapy on fracture rate have not been reported

Recovery from COVID-19:a sprint or marathon? 6-month follow-up data from online long COVID-19 support group members

Background: It remains unknown whether and to what extent members of online "long COVID" peer support groups remain symptomatic and limited over time. Therefore, we aimed to evaluate symptoms in members of online long COVID peer support groups up to 6 months after the onset of coronavirus disease 2019 (COVID-19)-related symptoms.Methods: Demographics, symptoms, health status, work productivity, functional status and health-related quality of life were assessed about 3 and 6 months after the onset of COVID-19-related symptoms in members of online long COVID peer support groups.Results: Data from 239 patients with a confirmed COVID-19 diagnosis (83% women; median (interquartile range) age 50 (39-56) years) were analysed. During the infection, a median (interquartile range) of 15 (11-18) symptoms was reported, which was significantly lower 3 and 6 months later: 6 (4-9) and 6 (3-8), respectively (p&lt;0.05). From 3 to 6 months follow-up, the proportion of patients without symptoms increased from 1.3% to only 5.4% (p&lt;0.001). Patients also reported a significantly improved work productivity (work absenteeism and presenteeism: 73% versus 52% and 66% versus 60%, respectively), self-reported good health (9.2% versus 16.7%), functional status (mean±sd Post-COVID-19 Functional Status scale: 2.4±0.9 versus 2.2±1.0) and health-related quality of life (all p&lt;0.05).Conclusion: Although patients with confirmed COVID-19, who were all members of online long COVID peer support groups, reported significant improvements in work productivity, functional status and quality of life between 3 and 6 months follow-up, these data clearly highlight the long-term impact of COVID-19, as approximately 6 months after the onset of COVID-19-related symptoms a large proportion still experienced persistent symptoms, a moderate-to-poor health, moderate-to-severe functional limitations, considerable loss in work productivity, and/or an impaired quality of life. Action is needed to improve the management and healthcare of these patients.</p