Tennessee v. Lane: Winning the Battle, Losing the War?

Mr. Foreman serves as deputy director for legal programs at the Lawyers Committee for Civil Rights under Law. He is a frequent speaker on civil rights issues and has served as counsel of record for the Lawyer\u27s Committee in several cases before the Supreme Court

Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience.

Abstract Introduction Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hypercalcemia. The aim of this study is to compare the efficacy and safety of total parathyroidectomy with subcutaneous forearm autotransplantation with total parathyroidectomy with intramuscular forearm autotransplantation. Materials and Methods A single-center retrospective cohort study of total parathyroidectomy with forearm autotransplantation from January 2002 to February 2013 was performed. According to the surgical technique, patients were divided into an intramuscular group (Group 1) and a subcutaneous group (Group 2). 38 patients with secondary hyperparathyroidism were enrolled; 23 patients were subjected to total parathyroidectomy with parathyroid tissue replanting in the subcutaneous forearm of the upper nondominant limb, while 15 patients were subjected to replanting in the intramuscular seat. Results A total of 38 patients (56 ± 13 years) were enrolled. In both groups, the preoperative iPTH value was markedly high, 1750 ± 619 pg/ml in the intramuscular autotransplantation group and 1527 ± 451 pg/ml in the subcutaneous autotransplantation group (p = 0.079). Transient hypoparathyroidism was shown in 7 patients, and 1 patient showed persistent hypoparathyroidism (p = 0.387). 2 patients showed persistent hyperparathyroidism (p = 0.816), and in 2 others was found recurrent hyperparathyroidism (p = 0.816); 3 of them underwent autograftectomy. The anterior compartment of the forearm nondominant limb was sacrificed in 1 case of intramuscular autotransplantation with functional arm deficit. Conclusions The efficacy and safety of parathyroid tissue autotransplantation in the subcutaneous forearm of the upper nondominant limb is confirmed with a good rate of tissue engraftment and with a comparable number of postsurgical transient and persistent hypoparathyroidism and hyperparathyroidism incidence in both techniques. Furthermore, this technique preserves arm functionality in the case of autograftectomy. Consequently, it is our opinion that total parathyroidectomy with subcutaneous forearm autotransplantation is currently the best choice

Bone mineral content after renal transplantation

Forearm bone mineral content (BMC), as evaluated by photonabsorption densitometry, was measured in 28 cadaver kidney donor recipients who entered the study 8 weeks postoperatively and were followed up for 18 months. BMC decreased signifiantly (p<0.05) but marginally in placebo-treated patients (n=14) (initial BMC 1.09±0.25 g/cm; final BMC 1.05±0.24). Fourteen patients were prophylactically given 1,25(OH)2vitamin D3 in a dose which avoided hypercalcemia and hypercalciuria (sim0.25 µg/day); under 1,25(OH)2 vitamin D3 prophylaxis a significant decrease of forearm BMC was observed no longer (initial BMC 0.94±0.21 g/cm; final BMC 0.95±0.21), but the difference between placebo and 1,25(OH)2 vitamin D3 narrowly missed statistical significance (p=0.066). It is concluded that the decrease of forearm BMC is negligible in transplant recipients with low steroid regimens. The data suggest a trend for prophylaxis with 1,25(OH)2 vitamin D3 to slightly ameliorate forearm (cortical) BMC loss

Categorical perception of tactile distance

The tactile surface forms a continuous sheet covering the body. And yet, the perceived distance between two touches varies across stimulation sites. Perceived tactile distance is larger when stimuli cross over the wrist, compared to when both fall on either the hand or the forearm. This effect could reflect a categorical distortion of tactile space across body-part boundaries (in which stimuli crossing the wrist boundary are perceptually elongated) or may simply reflect a localised increased in acuity surrounding anatomical landmarks (in which stimuli near the wrist are perceptually elongated). We tested these two interpretations, by comparing a well-documented bias to perceive mediolateral tactile distances across the forearm/hand as larger than proximodistal ones along the forearm/hand at three different sites (hand, wrist, and forearm). According to the ‘categorical’ interpretation, tactile distances should be elongated selectively in the proximodistal axis thus reducing the anisotropy. According to the ‘localised acuity’ interpretation, distances will be perceptually elongated in the vicinity of the wrist regardless of orientation, leading to increased overall size without affecting anisotropy. Consistent with the categorical account, we found a reduction in the magnitude of anisotropy at the wrist, with no evidence of a corresponding specialized increase in precision. These findings demonstrate that we reference touch to a representation of the body that is categorically segmented into discrete parts, which consequently influences the perception of tactile distance

Serum 25-Hydroxyvitamin D and Intact Parathyroid Hormone Influence Muscle Outcomes in Children and Adolescents

Increases in 25-hydroxyvitamin D concentrations are shown to improve strength in adults; however, data in pediatric populations are scant and equivocal. In this ancillary study of a larger-scale, multi-sited, double-blind, randomized, placebo-controlled vitamin D intervention in US children and adolescents, we examined the associations between changes in vitamin D metabolites and changes in muscle mass, strength, and composition after 12 weeks of vitamin D3 supplementation. Healthy male and female, black and white children and adolescents between the ages of 9 and 13 years from two US states (Georgia 34°N and Indiana 40°N) were enrolled in the study and randomly assigned to receive an oral vitamin D3 dose of 0, 400, 1000, 2000, or 4000 IU/d for 12 weeks between the winter months of 2009 to 2011 (N = 324). Analyses of covariance, partial correlations, and regression analyses of baseline and 12-week changes (post-baseline) in vitamin D metabolites (serum 25(OH)D, 1,25(OH)2 D, intact parathyroid hormone [iPTH]), and outcomes of muscle mass, strength, and composition (total body fat-free soft tissue [FFST], handgrip strength, forearm and calf muscle cross-sectional area [MCSA], muscle density, and intermuscular adipose tissue [IMAT]) were assessed. Serum 25(OH)D and 1,25(OH)2 D, but not iPTH, increased over time, as did fat mass, FFST, forearm and calf MCSA, forearm IMAT, and handgrip strength (p < 0.05). Vitamin D metabolites were not associated with muscle strength at baseline nor after the 12-week intervention. Changes in serum 25(OH)D correlated with decreases in forearm IMAT, whereas changes in serum iPTH predicted increases in forearm and calf MCSA and IMAT (p < 0.05). Overall, increases in 25(OH)D did not influence muscle mass or strength in vitamin D-sufficient children and adolescents; however, the role of iPTH on muscle composition in this population is unknown and warrants further investigation

Scale Invariance and Nonlinear Patterns of Human Activity

We investigate if known extrinsic and intrinsic factors fully account for the complex features observed in recordings of human activity as measured from forearm motion in subjects undergoing their regular daily routine. We demonstrate that the apparently random forearm motion possesses previously unrecognized dynamic patterns characterized by fractal and nonlinear dynamics. These patterns are unaffected by changes in the average activity level, and persist when the same subjects undergo time-isolation laboratory experiments designed to account for the circadian phase and to control the known extrinsic factors. We attribute these patterns to a novel intrinsic multi-scale dynamic regulation of human activity.Comment: 4 pages, three figure

A nodule on the forearm

Glomus tumors are benign tumors of the skin. Clinically, these tumors can present as solid, painful subcutaneous nodules, frequently seen on the hand (particularly subungual region). Glomangiomyomas are the least common histological type of glomus tumor. In the literature, there are only a few glomangiomyoma cases of the forearm location. We report a patient with a painful nodule, diagnosed as glomangiomyoma. Surgical excision was performed and no recurrence was observed after 5 years' follow-up

The Effect of self-controlled practice on forearm passing, motivation, and affect in women’s volleyball players

Motor learning research has suggested that self-controlled practice (or “autonomy”) leads to more effective learning of motor tasks. Debate continues, however, as to why. Most motor behaviorists maintain the better learning is due to cognitive and information-processing factors. Recently, others have proposed the learning enhancement is due to such psychological factors as motivation and affect. The present study sought to measure motor skill learning, intrinsic motivation, and affect in self-controlled versus externally-controlled (yoked) practice conditions. Participants, 16 collegiate women’s volleyball student-athletes from two National Collegiate Athletic Association Division I programs, were paired by forearm passing skill level, and one of each pair was randomly placed in either the self-control or yoked group. The self-control participants were asked to design their own forearm passing drill during the practice phase of the experiment. The yoked participants followed the design established by the self-control participant to whom they were yoked. Each of the participants’ forearm passing accuracy was measured in a free ball passing drill consisting of a pre-test and practice phase on Day 1, and a post-test on Day 2. Their intrinsic motivation was measured using the Intrinsic Motivation Inventory (IMI), and their positive and negative affect was measured using the Positive and Negative Affect Scale – Expanded Edition (PANAS-X). The IMI and PANAS-X were administered in a baseline condition (after a team practice one week prior to participation in the study) at the end of Day 1, and the end of Day 2. Analysis of the data revealed no statistically significant differences between groups in either forearm passing, intrinsic motivation, or affect. Further research is needed to determine if intrinsic motivation and affect are partially responsible for the learning benefits of self-controlled practice

Optimal dimensional synthesis of force feedback lower arm exoskeletons

This paper presents multi-criteria design optimization of parallel mechanism based force feedback exoskeletons for human forearm and wrist. The optimized devices are aimed to be employed as a high fidelity haptic interfaces. Multiple design objectives are discussed and classified for the devices and the optimization problem to study the trade-offs between these criteria is formulated. Dimensional syntheses are performed for optimal global kinematic and dynamic performance, utilizing a Pareto front based framework, for two spherical parallel mechanisms that satisfy the ergonomic necessities of a human forearm and wrist. Two optimized mechanisms are compared and discussed in the light of multiple design criteria. Finally, kinematic structure and dimensions of an optimal exoskeleton are decided

Survival to amputation in pre-antibiotic era: a case study from a Longobard necropolis (6th-8th centuries AD)

The Longobard necropolis of Povegliano Veronese dates from the 6th to the 8th centuries AD. Among the 164 tombs excavated, the skeleton of an older male shows a well-healed amputated right forearm. The orientation of the forearm fracture suggests an angled cut by a single blow. Reasons why a forearm might be amputated include combat, medical intervention, and judicial punishment. As with other amputation cases reported in literature, this one exhibits both healing and osteoblastic response. We argue that the forelimb stump morphology suggests the use of a prosthesis. Moreover, dental modification of RI2 shows considerable wear and smoothing of the occlusal surface, which points to dental use in attaching the prosthesis to the limb. Other indications of how this individual adjusted to his amputated condition includes a slight change in the orientation of the right glenoid fossa surface, and thinning of right humeral cortical bone. This is a remarkable example in which an older male survived the loss of a forelimb in pre-antibiotic era. We link archaeological remains found in the tomb (buckle and knife) with the biological evidence to show how a combined bioarchaeological approach can provide a clearer interpretation of the life history of an individual