Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome.

PURPOSE: To determine the incidence of revision and potential risk factors for needing revision surgery following in situ ulnar nerve decompression for patients with idiopathic cubital tunnel syndrome (CTS). METHODS: We conducted a retrospective chart review of all patients treated at 1 specialty hand center with an open in situ ulnar nerve decompression for idiopathic CTS from January 2006 through December 2010. Revision incidence was determined by identifying patients who underwent additional surgeries for recurrent or persistent ulnar nerve symptoms. Bivariate analysis was performed to determine which variables had a significant influence on the need for revision surgery. RESULTS: Revision surgery was required in 3.2% (7 of 216) of all cases. Age younger than 50 years at the time of index decompression was the lone significant predictor of need for revision surgery. Other patient factors, including gender, diabetes, smoking history, and workers\u27 compensation status were not predictive of the need for revision surgery. Disease-specific variables including nerve conduction velocities, McGowan grading, and predominant symptom type were also not predictive of revision. CONCLUSIONS: For patients with idiopathic CTS, the risk of revision surgery following in situ ulnar nerve decompression is low. However, this risk was increased in patients who were younger than 50 years at the time of the index procedure. The findings of this study suggest that, in the absence of underlying elbow arthritis or prior elbow trauma, in situ ulnar nerve decompression is an effective, minimal-risk option for the initial surgical treatment of CTS. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III

Evaluation and Management of Sleep Disorders in the Hand Surgery Patient.

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques.

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P \u3c .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P \u3c .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P \u3c .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P \u3c .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion: A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm

Databases Lie! Successfully Managing Structured Data, the Oft-Overlooked ESI

Legal professionals regularly advise clients to ensure that the storage, retention, and accessibility of their Electronically-Stored Information (“ESI”) is in full compliance with all legal and regulatory requirements in the event this information becomes relevant in civil, criminal, or regulatory disputes. However, what many practitioners may not realize is that the ESI that clients are required to produce for e- discovery includes both “unstructured” and “structured” data. Searching and producing only one of these types of ESI may well not fully satisfy a client’s full discovery obligations. Even worse, it might not present a full understanding of the factual issues in the matter and how to best prove them to the legal team

The Effects of Eisen IV and Proposed Amendments of Federal Rule 23

This Article was written for the purpose of revitalizing Rule 23 (b) (3) class actions following the rulings of Snyder, Zahn and especially Eisen IV. These three Supreme Court opinions were analyzed carefully in order to determine whether such effort is possible without any constitutional amendment. The principal innovation of the spurious class action in 1966 was the rule that, while formerly class members had to take affirmative steps to participate in the class, now they are bound by the class action unless they opt out. In the authors\u27 view, this 1966 change of policy was sound, especially in the fields of consumer, environmental, and mass tort litigation, and it should be preserved. Without it, some of that litigation would be most difficult to handle

Enabling Domain-Specific Rule-Based Automation With Semantic Stream Technology

The aim of this study is to consolidate semantics, streaming and user-centered rulebased home automation with the goal of thereby enabling more powerful and more user-friendly home automation systems. To reach this goal this thesis incorporates the rather new field of semantic streaming into home automation taking into account the users\u27 needs and perspective. This thesis contributes a structured literature review on rule-based home automation use cases including their classification by new criteria. As part of the analysis a participatory design study was conducted yielding that users prefer visual languages in the domain of home automation. Furthermore a new pattern in semantic streaming was discovered called dynamic sensor selection. As main contribution of this thesis a home automation system based on semantic streaming called ERAS (Event and Rule Automation System) was developed using two hierarchically-aligned visual languages called Event Language (EL) and Rule Language (RL). ERAS was completely implemented also containing an editor for each of the two visual languages. As existing semantic streaming engines and benchmarks for semantic streaming engines did proof not suitable a custom semantic streaming engine called ECQELS (Extended Continuous Query Evaluation over Linked Stream) was designed and implemented as well as a corresponding benchmark introducing the average response time as relevant feature for comparison of semantic streaming engines. The system developed in this thesis was evaluated by performing the implemented benchmark on ECQELS comparing it to CQELS, probably the most powerful existing semantic streaming engine, which yielded that ECQELS can compete with CQELS for rather simple queries. When executing multiple queries simultaneously ECQELS event outperforms CQELS. Furthermore a user acceptance study was conducted as part of the evaluation comparing the visual language EL and the textual language ECQELS regarding usability. As outcome of the study EL was slightly preferred by the users in most cases but differences could not be proven significantly. On the basis of the results of this research, it can be concluded that the use of semantic streaming technologies in the domain of home automation has the potential to provide great benefits for developing more powerful and nevertheless more userfriendly home automation systems

Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members.

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members\u27 Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). Hand-surgeons-per-capita and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state\u27s average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. Results: A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states\u27 average reimbursement, reimbursement was not significantly correlated with the state\u27s hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Conclusions: Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons\u27 peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons

Revitalizing Turtle Creek Park

We current ENST 411 students, Abbey Jacoby, Michael Hardyway, Ethan Harm, and Casey Stephenson have chosen to work with Jim Knight, East Buffalo Township, the Merrill Linn Land and Waterways Conservancy, and many others in an attempt to revitalize Turtle Creek Park for a plethora of reasons. Three of us are majoring in biology, and two are majoring in environmental science, which makes much of the information and techniques relevant in Turtle Creek applicable to our courses of study. This project included heavy hands on work which allowed us students to leave a memorable and impactful influence on the Lewisburg community. Post-graduation, the Turtle Creek Project will provide a continued source of outdoor recreation and conservation for local species regardless of our presence on campus. In addition, several of us will be pursuing environmental studies and sciences careers after graduation, where we will use our skills and knowledge obtained from the Turtle Creek Park experience. Overall, the park revitalization project provided an opportunity to connect with the local natural ecosystem in ways we have not experienced before, and also allowed each of us to build unique connections to figures important in the field of conservation and environmental studies here in Pennsylvania

Use of medical, surgical and complementary treatments among women with fibroids

OBJECTIVE: To examine the use of medical management, uterus-preserving surgery (UPS), and complementary treatments among women with uterine fibroids. STUDY DESIGN: Prospective cohort study of 933 premenopausal women ages 31-54 years with symptomatic fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of fibroid treatments was determined through annual interviews. Linear regression models were used to compare changes in fibroid-related symptoms among women who underwent UPS versus those who did not undergo surgery. RESULTS: Participants were racially and ethnically diverse, with a mean age of 43 years. During study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%) had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative treatments were commonly used, including exercise (45%), diet (34%), herbs (37%), and acupuncture (16%): participants reported significant symptom improvement and few side effects with these interventions. In multivariable linear regression models, women who did not undergo surgery during the study reported improvement in dyspareunia (p<.001), pelvic pain (p<.001), and menstrual cramps (p<.001). However, women who underwent UPS reported greater overall resolution of "pelvic problems" compared with women who did not have surgical treatment (difference in change score 1.18 on a four-point Likert scale, p<.001). CONCLUSION: UPS are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention

Searching for Faint Planetary Nebulae Using the Digital Sky Survey

Recent Halpha surveys such as SHS and IPHAS have improved the completeness of the Galactic planetary nebula (PN) census. We now know of ~3,000 PNe in the Galaxy, but this is far short of most estimates, typically ~25,000 or more for the total population. The size of the Galactic PN population is required to derive an accurate estimate of the chemical enrichment rates of nitrogen, carbon, and helium. In addition, a high PN count (~20,000) is strong evidence that most 1-8 Msun main sequence stars will go through a PN phase, while a low count (<10,000) argues that special conditions (e.g., a close binary interaction) are required to form a PN. We describe a technique for finding hundreds more PNe using the existing data collections of the digital sky surveys, thereby improving the census of Galactic PNe.Comment: 11 pages, 7 figures, accepted for publication in the Publications of the Astronomical Society of Australia (PASA), full resolution paper available at http://www.wiyn.org/jacoby_pasa.pd