Thoracic Outlet Syndrome

CLINICAL PRESENTATION & EXAM: Thoracic Outlet Syndrome (TOS), a term first coined by Peet in 1956, is a controversial condition that is difficult to diagnose. Commonly characterized by neck and shoulder pain, TOS occurs due to complex mechanisms involving muscular dysfunction and neurovascular compression. Extremely rare in children, TOS affects young women more than men. Patients with a history of trauma around the thoracic outlet area, as well as people who engage in repetitive muscular activity such as competitive baseball pitchers and swimmers, are at an increased risk of TOS. Cases of TOS are classified as vascular (arterial or venous) or neurogenic. In cases of vascular TOS, symptoms can include ischemia in the digits, claudication in the arm, discoloration, pain, and swelling or muscle atrophy. However, about 90-95% of total TOS cases are of the neurogenic type. Patients with this condition may experience numbness, paresthesia, grip weakness, and radiating pain down the arm or to the ear, face, and occiput. ANATOMY & PATHOLOGY: The thoracic outlet is a passageway from the lower neck to the armpit through which veins, arteries, and nerves pass. In TOS, abnormal compression of this area between the clavicle and the first rib results in irritation of the nerves and blood vessels. Most often, muscular dysfunction and imbalance in the cervicoscapular region creates intermittent nerve compression and/or tension on the brachial plexus, resulting in pain and discomfort. TOS can be the result of congenital abnormalities, trauma or injury to the thoracic region, functional acquired causes, and other unidentified sources. DIAGNOSTIC TESTING & CONSIDERATIONS: Due to the diversity of possible symptoms and the variability displayed in patients, TOS presents a diagnostic dilemma to the physician. Diagnosis is based on proper history, physical examination, direct observation and provocation tests, such as Adson’s, Roos’, and Elvy’s maneuvers. These tests consist of manipulating the limbs to add stress onto the thoracic outlet region, thereby eliciting TOS symptoms in less than one minute and assisting in making a diagnosis. Different imaging techniques, such as X-rays and MRIs of the neck and shoulder areas, may be used to reveal a structural abnormality or to locate the site of vascular compression. Nerve conduction tests and an EMG can also be used to detect nerve damage. An arteriography or venography may be performed to inspect vascular functioning. TREATMENT & RETURN TO ACTIVITY: Preventative measures can be taken to correct or eliminate risk factors in regards to the workplace or home ergonomics. If diagnosed early, a conservative approach to treatment consisting of physical therapy can be effective. Exercises that focus on improving posture, increasing range of motion, and stretch muscles around the thoracic outlet can alleviate the symptoms. Non- surgical treatment may also include anesthetic agents, steroids, and botulinum toxin type A (BTX-A) injections. If conservative treatment is ineffective (2-12 months), surgery may be recommended. Typically, the first rib is surgically removed to create more space in the thoracic outlet and alleviate compression on the vessels and nerves. Depending on the severity of the syndrome and the surgeon’s approach to either total or partial removal of the rib and adjacent muscles, outcomes are usually good but a minority of patients may experience a recurrence of symptoms

A Framework for the Flexible Integration of a Class of Decision Procedures into Theorem Provers

The role of decision procedures is often essential in theorem proving. Decision procedures can reduce the search space of heuristic components of a prover and increase its abilities. However, in some applications only a small number of conjectures fall within the scope of the available decision procedures. Some of these conjectures could in an informal sense fall ‘just outside’ that scope. In these situations a problem arises because lemmas have to be invoked or the decision procedure has to communicate with the heuristic component of a theorem prover. This problem is also related to the general problem of how to exibly integrate decision procedures into heuristic theorem provers. In this paper we address such problems and describe a framework for the exible integration of decision procedures into other proof methods. The proposed framework can be used in different theorem provers, for different theories and for different decision procedures. New decision procedures can be simply ‘plugged-in’ to the system. As an illustration, we describe an instantiation of this framework within the Clam proof-planning system, to which it is well suited. We report on some results using this implementation

Complexity of short Presburger arithmetic

We study complexity of short sentences in Presburger arithmetic (Short-PA). Here by "short" we mean sentences with a bounded number of variables, quantifiers, inequalities and Boolean operations; the input consists only of the integers involved in the inequalities. We prove that assuming Kannan's partition can be found in polynomial time, the satisfiability of Short-PA sentences can be decided in polynomial time. Furthermore, under the same assumption, we show that the numbers of satisfying assignments of short Presburger sentences can also be computed in polynomial time

Subclasses of Presburger Arithmetic and the Weak EXP Hierarchy

It is shown that for any fixed $i>0$, the $\Sigma_{i+1}$-fragment of Presburger arithmetic, i.e., its restriction to $i+1$ quantifier alternations beginning with an existential quantifier, is complete for $\mathsf{\Sigma}^{\mathsf{EXP}}_{i}$, the $i$-th level of the weak EXP hierarchy, an analogue to the polynomial-time hierarchy residing between $\mathsf{NEXP}$ and $\mathsf{EXPSPACE}$. This result completes the computational complexity landscape for Presburger arithmetic, a line of research which dates back to the seminal work by Fischer & Rabin in 1974. Moreover, we apply some of the techniques developed in the proof of the lower bound in order to establish bounds on sets of naturals definable in the $\Sigma_1$-fragment of Presburger arithmetic: given a $\Sigma_1$-formula $\Phi(x)$, it is shown that the set of non-negative solutions is an ultimately periodic set whose period is at most doubly-exponential and that this bound is tight.Comment: 10 pages, 2 figure

The influence of heat treatment and finishing on the mechanical properties of laminar composites

The aim of this investigation was to define the optimum conditions of obtaining glass fabric - epoxy resin laminar composites with appropriate mechanical properties that satisfy the quality needed for production of printed circuit boards for microelectronics. Commercial materials: domestic glass woven fabric, different types of silane finish and epoxy resin were starting materials in obtaining composites. The conditions needed for the thermal removal of the original size from glass fabric were investigated. The optimal heat treatment should be performed on temperatures less than 550C, while cooling rate should be as slow as possible. In this manner the fabric has less than 0.1% of residual size, and the mechanical properties remain satisfactory. Two most commonly used silane based finishes were applied on heat-treated glass fabric. Tensile strength of the composite material made of thermally and chemically treated glass fabric and epoxy resin was investigated. The possibility of using domestic glass fabric in production of printed circuit boards for microelectronics has been confirmed. Finish with amino functional group and lower heat treatment temperature should be used for obtaining glass-fabric epoxy resin laminar composites with desirable mechanical properties

Yugoslav Jewish officers in prisoners of war

Brz i totalan slom stare Jugoslavije izazvao je preneraženost i iznenađenje u svim krugovima sveta koji su bili neraspoloženi prema hitlerizmu i sličnim fašističkim ideologijama. Utoliko je veća bila preneraženost i dezorijentisanost samih Jugoslovena koji su neposredno bili pogođeni brzom i totalnom pobedom Nemačke nad Kraljevinom Jugoslavijom. Ljudi u tim trenucima nisu ni shvatili kakav je nestabilan bio stari politički režim, kako je bio pun slabosti, unutrašnjih suprotnosti, nerešenih socijalnih i političkih problema. Sve političke i druge iluzije na kojima se bio držao stari režim odjednom su se raspršile. Može se onda zamisliti kako je sve to pogodilo Jevreje u staroj Jugoslaviji. Bili su u paničnom strahu i očajanju. Pored poznate nacističke istrebljivačke politike prema Jevrejima, strah jugoslovenskih Jevreja povećavala je i okolnost što je Hitler bio naročito besan na njih zbog 27. marta. On je prema svojoj opštepoznatoj dogmi "Jevreji su za sve krivi" i preokret od 27. marta takođe pripisao njima. I zaista, obračun sa jugoslovenskim jevrejstvom bio je užasan i beskompromisan. To opšte raspoloženje Jevreja u staroj Jugoslaviji nije mimoašlo ni one koji su pripadali vojsci stare Jugoslavije. Ti Jevreji, bar njihov veliki broj, bili su oni za borbu, mnogi su se dobrovoljno javili u vojsku pre nego što im je stigao poziv za mobilizaciju, ili su se javili iako nisu imali ratni raspored. Neki od njih su i poginuli u borbama aprila 1941. godine, a mnogi su pali u zarobljeništvo. U tom trenutku njihova situacija izgledala je beznadežna; bili su u očajanju i depresiji. Grubi diskriminatorski postupci počeli su prema njima odmah posle zarobljavanja, kao i za vreme transporta. Već tada se čuo čuveni uzvik koji je Jevreje - zarobljenike pratio u toku celog zarobljeništva: "Die Juden heraus" - "Neka iziđu Jevreji". Iako ovo posebno prebrojavanje Jevreja nije uvek imalo nekog smisla ili naročitog cilja, ono je mnogo doprinelo da se strah i dezorijentisanost Jevreja povećaju. Nemci su već prilikom zarobljavanja počeli svoju poznatu politiku razdvajanja i zavađivanja raznih jugoslovenskih naroda i narodnosti, pa su pojedini iz tih grupa i grupacija ispoljavali antisemitski stav prema Jevrejima još za vreme transporta. Sve ove okolnosti, a najviše samo osećanje da ih vode nekud u unutrašnjost Hitlerove Nemačke, os- tavilo im je malo nade da će ikad sve to preživeti.In this work, the author writes about the participation of the Yugoslav Jewish officers in the struggle waged in the prisoners of war camps in Germany in support of the Peoples' Liberation War of the peoples of Yugoslavia. He points to the general disillusionment and disorientation of the officers of the former Yugoslav royal army who found themselves in German captivity after the sudden and complete collapse and the break-up of the Kingdom of Yugoslavia. Those officers who were Jews had even more reasons for despair when in camps in the heartland of Nazi Germany. Reference is made to the status of Jewish prisoners of war in the Nürnberg camp where they were ordered, in spite of protest, to carry on their uniform a yellow star marked "Jude", and where they were exposed by the German command to other discriminatory measures as well. At the same time, the majority of non-Jewish officers demonstrated marked solidarity with their Jewish colleagues. The first steps of the illegal Communist Party in the Nürnberg camp are also described. Its primary aim those days was to make the disoriented officers get rid of their despair and to inject in their thinking a faith in the victory of the Allies and in the rebirth of Yugoslavia in which new social forces will make the strivings and aspirations of the Yugoslav people a reality. Reference is made to the Jewish officers who were members of the leadership of the illegal organizations. After the transfer of the Jewish officers from Nürnberg to the Osnabrück camp in May 1942, practically all the Jewish officers in German captivity, about 400 of them, found themselves concentrated in that camp. Within the Osnabrück camp the political struggle became a day to day affair and the polarization of forces which, generally speaking, divided the officers into two groups was practically completed: one group advocated the reestablishment of the old regime, the kingdom, while the other stood for the uncompromising struggle against the occupiers offering at the same time prospects of a new social order. This second group was organized and lead by the illegal Communist Party in the camp and was, in fact, part of the mass movement in Yugoslavia where the armed struggle against the occupiers was based on the support of broad masses of the people. The overwhelming majority of the Jewish officers joined this second group and participated in the political, cultural, professional and other activities. After an intensive phase of the struggle in the camp was over, the Jewish officers and about 400 other officers marked as "dangerous communist elements" were secluded in the so-called "D” camp which was separated from the other parts of the camp by a barbed-wire fence and protected by a special armed guard. A number of Jewish officers were included in the illegal activity the Communist Party organized in the camp. During a period of time, the centre of this illegal activity was in the Jewish barrack No. 37, in room No. 7. Here a radio set was kept, here the allied stations were listened to and a daily news bulletin edited to be sent through established channels to those barracks which housed the members of the organization. There was also the technical service of the illegal organization which was responsible for the hiding of pieces of arms the organization succeeded to acquire and of other materials and tools used by the illegal technical service. Jewish participation was also marked in the legal activities coordinated by the Cultural Board and guided by the leadership of the illegal organization. Jewish officers were active in the professional associations (of lawyers, engineers, and other), in the drama and musical society, in the literary circles, practically in all activities in the camp. Out of many events of political importance a few are singled out and described in more details, such as the demand for elections within the camp to be held in accordance with the provisions of the Geneva Convention, the refusal of food because of its poor quality, and a few other events. The participation of Jewish officers in all these encounters in the camp is referred to as one of the causes of their transfer as a group, in August 1944, to Strasbourg camp were they continued their active political role. Because of the advance of the Allies, they were transferred subsequently to the camp in Barkenbrügge, near the former Polish frontier to be moved again towards the west, in January 1945, when the westward advance of the Red Army was in full swing. One group of the prisoners of war, a number of Jewish officers among them, succeeded to get rid of German guards and to reach Yugoslavia already in March 1945, travelling with the assistance of the Soviet authorities through Poland and Rumania. The other group had to go four weeks on foot westward under very difficult conditions. The group was sent to the former concentration camp in Alexisdorf, near the Duch frontier and was later ordered to go on foot south-west to be eventually left without guards and liberated by the British troops. A number of liberated officers, with quite a few Jews among them, remained for a while in Germany as liaison officers with the allied troops or attached to various Yugoslav missions in charge of repatriation, restitution and similar important duties of those days. Those who were repatriated, just as the members of the first-mentioned group, either joined the Army or were given duties in the administration of the country

Hebräische Fibel, oder: Erster Unterricht im Hebräischlesen und Uebersetzen : nach grammatikalischen Grundsätzen bearbeitet

von L. Presburger, Lehrer an der Israelistischen Bürger- und Realschule zu Frankfurt a.M. ; mit einem Vorworte von Dr. M. Heß, OberlehrerTalmud ḳeriat ʿivriתלמוד קריאת עבריTeilweise in Fraktur, teilweise in hebräischer Schrif