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Despite normal neurological bedside and electrodiagnostic, some patients with non-specific neck arm pain (NSNAP) have heightened nerve mechanosensitivity upon neurodynamic testing [1, 2]. It remains however unclear whether this is associated with a minor nerve injury. The aim of this study was to evaluate potential differences in somatosensory function among patients with unilateral NSNAP with and without positive neurodynamic tests and healthy controls.
Quantitative sensory testing was performed in 40 patients with unilateral NSNAP; 23 with positive upper limb neurodynamic tests (ULNTPOS) and 17 with negative neurodynamic tests (ULNTNEG). The protocol comprised thermal and mechanical detection and pain thresholds as well as mechanical pain sensitivity, wind-up ratio and dynamic mechanical allodynia. All parameters were measured in the maximal pain area on the affected side as well as over the corresponding area on the unaffected side. Symptom severity, functional deficits, psychological parameters, quality of life and sleep disturbance were also recorded.
Fifty-seven percent of patients with NSNAP had positive neurodynamic tests despite normal bedside neurological integrity tests and nerve conduction parameters. Clinical profiles did not differ between patient groups. Somatosensory profiling revealed a more pronounced loss of function phenotype in ULNTPOS patients compared to healthy controls. Hyperalgesia (cold, heat and pressure pain) was present bilaterally in both NSNAP group. The ULNTNEG subgroup represented an intermediate phenotype between ULNTPOS patients and healthy controls in both thermal and pressure pain thresholds as well as mechanical detection thresholds.
In conclusion, heightened nerve mechanosensitivity was present in over half of patients with NSNAP. Our data suggest that NSNAP presents as a spectrum with some patients showing signs suggestive of a minor nerve dysfunction.
[1] Elvey RL. Physical evaluation of the peripheral nervous system in disorders of pain and dysfunction. J Hand Ther 1997;10:122-129.
[2] van der Heide B, Bourgoin C, Eils G, Garnevall B, Blackmore M. Test-retest reliability and face validity of a modified neural tissue provocation test in patients with cervicobrachial pain syndrome. J Man Manip Ther 2006;14:30-36.
Niche-based species distribution models (SDMs) play a central role in studying species response to environmental change. Effective management and conservation plans for freshwater ecosystems require SDMs that accommodate hierarchical catchment ordering and provide clarity on the performance of such models across multiple scales. The scale-dependence components considered here are: (a) environment spatial structure, represented by hierarchical catchment ordering following the Strahler system; (b) analysis grain, that included 1st to 5th order catchments; and (c) response grain, the grain at which species respond most, represented by local and upstream catchment area effects. We used fish occurrence data from the Danube River Basin and various factors representing climate, land cover and anthropogenic pressures. Our results indicate that the choice of response grain – local vs. upstream area effects – and the choice of analysis grain, only marginally influence the performance of SDMs. Upstream effects tend to better predict fish distributions than corresponding local effects for anthropogenic and land cover factors, in particular for species sensitive to pollution. Key predictors and their relative importance are scale and species dependent. Consequently, choosing proper species dependent spatial scales and factors is imperative for effective river rehabilitation measures.
Niche-based species distribution models (SDMs) have become an essential tool in conservation and restoration planning. Given the current threats to freshwater biodiversity, it is of fundamental importance to address scale effects on the performance of niche-based SDMs of freshwater species’ distributions. The scale effects are addressed here in the context of hierarchical catchment ordering, considered as counterpart to coarsening grain-size by increasing grid-cell size. We combine fish occurrence data from the Danube River Basin, the hierarchical catchment ordering and multiple environmental factors representing topographic, climatic and anthropogenic effects to model fish occurrence probability across multiple scales. We focus on 1st to 5th order catchments. The spatial scale (hierarchical catchment order) only marginally influences the mean performance of SDMs, however the uncertainty of the estimates increases with scale. Key predictors and their relative importance are scale and species dependent. Our findings have useful implications for choosing proper species dependent spatial scales for river rehabilitation measures, and for conservation planning in areas where fine grain species data are unavailable.
Despite similar policy goals, the adoption of eHealth practices took different paths in Austria (AT), Switzerland (CH), and Germany (GER). We seek to provide a rigorous analysis of the current state of hospitals by focusing on three key eHealth areas: electronic patient records (EPR), health information exchange (HIE), electronic patient communication. For validation and in order to gain better contextual insight we applied a mixed method approach by combining survey results from clinical directors with qualitative interview data from eHealth experts of all three countries. Across countries, EPR adoption rates were reported highest (AT: 52%, CH: 78%, GER: 50%), HIE-rates were partly lower (AT: 52%, CH: 14%, GER: 17%), and electronic patient communication was reported lowest overall (AT: 17%, CH: 8%, GER: 19%). Amongst others, results indicate patient awareness about eHealth to be equally weak across countries, which thus may be an important focal point of future policy initiatives.
We describe an automated approach, to easily track patients regaining their walking ability while recovering from neurological diseases like e.g. stroke. Based on captured gait data and objective measures derived out of it the rehabilitation process can be optimized and thus steered. In order to apply such system in clinical practice two key requirements have to be fulfilled: (i) the system needs to be applicable in terms of ease of use and performance; (ii) the derived measures need to be accurate.
Rationale:
Dance as an intense kind of performance is associated with high loads on the musculoskeletal system. In particular, the lower limb is exposed to these high loads, which is reported by a high prevalence. Most dancers are affected by injuries during their careers, most in the lower limb. Typical risk factors for dancers include the compensatory turnout, hypermobility, and core stability. The correlation between these factors and lower limb injuries is not fully understood.
Purpose:
The aim of this study was to evaluate the correlation between lower limb injuries and the risk factors compensated turnout, hypermobility and core stability. Based on these results, hypotheses can be generated for further studies.
Methods:
This explorative pilot study was conducted at Osnabrück University of Applied Sciences. All eligible participants were scheduled for a single research appointment if they fulfilled the inclusion criteria of dance experience (ballet, modern, contemporary or jazz) at least one year with dance lessons of at least 5 hours per week. Parameters for the correlation analysis were (1) core stability, measured by the motor control tests battery proposed by Luomajoki, (2) hypermobility, measured by the Beighton Score (3) compensated turnout, measured by the difference between functional turnout and external rotation of both hips, (4) dance hours per week, (5) dance experience in years, (6) professional dance experience in years and (7) dance style (ballet, modern, contemporary, jazz). These parameters were correlated with the numbers of lower limb injuries. Significance level was set at 90% because of the explorative character of the study with the purpose to generate hypotheses.
Results:
Sixteen female dancers with different levels of dance experience (mean 11.3 years) and dance lessons per week (mean 17.6 hours) fulfilled the inclusion criteria and participated in this study. Significant correlations with the numbers of lower limb injuries were found at core stability (rs=0.489, p=0.034, medium effect), dance hours per week (rs=0.459, p=0.048, medium effect) and professional dance experience in years (rs=0.396, p=0.093, medium effect). Two dance styles (modern dance: rs=0.388, p=0.101 and contemporary dance: rs=0.385, p=0.104) were close to the significance level.
Conclusions:
These results show correlations between core stability, dance hours per week, professional dance experience in years and lower limb injuries in dancers.
Due to the limitations of a small and heterogeneous sample size as well as the medium effects, these results should be interpreted with caution, but may provide a basis for further research to this topic in the field of dance research and can be helpful in generating research hypotheses.
Relationship of QST measures between low back and leg sites in people with radicular leg pain
(2019)
Background and Aims
Clinicians and researchers often rely on altered neurological integrity tests in the leg to identify radicular pain, however neurological integrity is often not tested in the low back region even in the presence of pain in this region. There have been suggestions that the low back pain itself could be neuropathic in nature in some patients (Baron et al., 2016). This study aims to explore the relationship between quantitative sensory testing (QST) measures in the leg and low back in participants with radicular leg pain to consider if sensory testing should be performed in both areas in clinical practice.
Methods
13 participants (mean age 48.2 SD 13.8, gender (female) 8) with radicular leg pain were recruited from National Health Service spinal clinics in the UK. After assessment with the clinician, a full QST profile was taken from each participant’s affected leg and low back. Z scores were calculated using data from age matched healthy controls. Correlations using Pearson’s if the data was normally distributed or Kendall’s Tau-b if not, were undertaken between QST scores of the low back and leg. Paired t tests or Mann Whitney tests were performed to assess differences in QST scores between the leg and low back regions.
Results
There were no significant correlations (P>0.05) in any of the QST measures between the leg and the low back regions. However, only vibration detection threshold measures showed statistically significant differences between the leg and low back (p<0.001), with the low back region showing greater loss of function (mean -2.84) than the leg (mean -0.61).
Conclusions
Significantly lower vibration thresholds were found in the back compared to the leg. This may suggest some alteration in posterior primary ramus large diameter afferent nerve function, and indicate that the low back pain itself may indeed have a neuropathic component. Our findings suggest that sensory testing of the lumbar spine may be advisable in this group of individuals. The small sample size means that these results must be taken with some caution, however these results warrant further investigation in people with radicular leg pain.
Talent scarcity in emerging economies such as India poses challenges for companies. Limited labour market participation among well-educated women has been observed. The reasons that professionals decide not to pursue a further corporate career remain unclear. By investigating their career decision making, this handout summerizes research results from a study that aims to highlight the contextual factors that impact those decisions.
Following a qualitative research design interviews with internationally experienced Indian business professionals show that rebellion against Indian societal and family expectations is essential to following a career path, especially for women. The current institutional framework of society and organizations serves as a legitimizing façade veiling traditional practices that hinder females’ careers.