Clinical management of carpal tunnel syndrome: a 12-year review of outcomes

Carpal tunnel syndrome (CTS) is a disorder frequently encountered by occupational health care specialists. The health care management of this disorder has involved a diverse set of clinical procedures. The present article is a review of the literature related to CTS with an emphasis on occupational-related CTS. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, and NIOSHTIC databases from 1985-1997 were searched for treatment outcome studies related to CTS. Treatments of interest included surgery, physical therapy, drug therapy, chiropractic treatment, biobehavioral interventions, and occupational rehabilitation. A systematic review of the effects of these interventions on symptoms, medical status, function, return to work, psychological well-being, and patient satisfaction was completed. Compared to other treatments, the majority of studies assessed the effects of surgical interventions. Endoscopic release was associated with higher levels of physical functioning and fewer days to return to work when compared to open release. Limited evidence indicated: 1) steroid injections and oral use of B6 were associated with pain reduction; 2) in comparison to splinting, range of motion exercises appeared to be associated with less pain and fewer days to return to work; 3) cognitive behavior therapy yielded reductions in pain, anxiety, and depression; and, 4) multidisciplinary occupational rehabilitation was associated with a higher percentage of chronic cases returning to work than usual care. Workers' compensation status was associated with increased time to return to work following surgery. Conclusions are preliminary due to the small number of well-controlled studies, variability in duration of symptoms and disability, and the broad range of reported outcome measures. While there are several opinions regarding effective treatment, there is very little scientific support for the range of options currently used in practice. Despite the emerging evidence of the multivariate nature of CTS, the majority of outcome studies have focused on single interventions directed at individual etiological factors or symptoms and functional limitations secondary to CTS.     

Real time pricing to assist in load frequency control

The use of real-time prices (i.e. pricing in the presence of system dynamics) to assist in the control of frequency and tie-line deviations in electric power systems is discussed. Under idealized assumptions, prices for load frequency control are derived that reflect the underlying physical relationships of the power system. Applying the theoretical results to a simple example, real-time prices determined by a feedback control law for frequency deviations are shown to aid in load frequency control. It is concluded that real-time pricing could serve as the basis of an economic load/shedding policy to assist the direct control by the electric utility     

Oxidation of amino groups by hydroxyl radicals in relation to the oxidation degree of the alpha-carbon

Nitrogen organic compounds constitute a large class of aqueous pollutants. These compounds include not only azoic structures, nitrogen heterocycles, and nitrous groups but also amides and amines. This work consisted in studying the OH* induced oxidation of simple primary amines in dilute aqueous solution with special attention to mineralization of the nitrogen group as a function of the nature of the alpha-carbon. H2O2/UV and gamma-irradiation processes were used for the production of OH* radicals, and the molecules studied were one alpha-amino acid i.e., glycine (HOOCCH2NH2), and two primary amides i.e., acetamide (CH3CONH2) and oxamic acid (HOOCCONH2). It was shown that the oxidation of glycine leads to the formation of ammonia, whereas the acetamide molecule is first oxidized into oxamic acid ending in complete mineralization with production of nitrates. Reaction mechanisms are proposed which account for the observed inorganic nitrogen end product depending on the oxidation degree of the carbon atoms of the molecules. It follows that the present study will allow for prediction of the fate of nitrogen resulting from the oxidation of primary amino groups by OH* radicals.     

Thermoluminescence dating of archaeological artefacts from the Middle Neolithic,Bronze Age and the Roman Empire period

Thermoluminescence (TL) dating was applied for artefacts found near the small village of Michelstetten, Lower Austria. Settlements in this region can be traced hack a long time and, according to archaeologists, the discovered artefacts may be as old as 6000 years. A modified sample preparation technique based on the fine-grain method was developed. This technique results in a higher reproducibility and reduces the overall preparation time. For some artefacts the new information of the TL dating leads to an unforeseen re-interpretation of the archaeological age. Furthermore, an iron furnace from the period of the Roman Empire could be dated. For the first time, it was possible to estimate correctly the point of time of the burn-down of an ancient wooden house via an analysis of the house's clay plaster. The fire took place in the sixth century; this was confirmed by dating ceramic artefacts.     

Voluntary pacing and energy cost of off-road cycling and running

PURPOSE: The purposes of this study were (1) to compare self-chosen speed of off-road cyclists and runners on a hilly course, (2) to compare the energy expenditure of off-road cyclists and runners on the same terrain, and (3) to describe changes in energy expenditure over the course of the exercise period. METHODS: Runners and cyclists performed three laps on a 2.75 km gravel course in a single exercise bout. The course was divided into 13 segments differing in grade and length. Position on the course and heart rate were recorded every few seconds. Speed was computed for each course segment on each lap; energy expenditure was estimated using recorded heart rates and exercise-specific maximal oxygen uptake measurements made prior to participation in the study. RESULTS: There were significant relationships between grade and speed for both runners (r = 0.64) and cyclists (r = 0.44). The differences between cyclists and runners were greatest on downhill segments. Energy expenditure rates were not significantly different for runners (71.6% VO2 peak) and cyclists (68.5% VO2 peak). CONCLUSIONS: Off-road cycling and running are comparable in energy demands. Variation in skill levels may account for the increased variability in speed among cyclists on downhill terrain.     

Integrated Optics for Astronomical Interferometry. III. Optical Validation of a Planar Optics Two-Telescope Beam Combiner

The optical characterization of a fiber-connected planar optics beam combiner dedicated to astronomical interferometry for two telescopes is presented. The beam combiner, fully integrated on a single 5 mm x 40 mm glass chip, is tested as the central part of an astronomical instrument. The single-mode waveguides are made by silver-ion-exchange technology upon glass substrates and provide spatial filtering, which improves the visibility measurement accuracy by selecting only the fundamental mode of the beams at the telescope focal plane. A global optical throughput of 43% is measured, and the sources of losses are identified and examined in detail. Solutions for improving this throughput are proposed. High and stable contrasts are obtained with a 1.55-mum laser diode (?96%) and with a white-light source (~92%) in the astronomical H filter (1.43 mum; 1.77 mum). The need for accurate control of differential instrumental polarization is demonstrated. In this context the intrinsic polarization-maintaining property of the planar optics component is characterized. This validation of the important potential uses of integrated planar optics should be valuable for future design of optical telescope arrays.     

Interactions among factors affecting stillbirths in Holstein cattle in the United States

Each year about 7% of the Holstein calves born in the United States die within 48 h of birth. The exact cause of death is unknown. The purpose of this article is to examine the complex interactions among factors (e.g., parity, season of birth, dystocia, year) contributing to stillbirth rates. A modified chi-squared automated interaction detection algorithm was used to develop classification trees explaining the most likely sequence of factors that result in a stillborn calf. The data were 666,341 births from the MidStates Dairy Records Processing Center and the National Association of Animal Breeders. Primiparous and multiparous cows clearly differ in the rate of stillbirths, 11.0 and 5.7%, respectively. Dystocia followed parity as the next most important factor within both primiparous and multiparous cows. In primiparous cows, season, year of birth, or gestation length ranked third as an important predictor for dystocia equal to 1, 2, or 3+, respectively. Gestation length ranked third in importance among the factors that affect stillbirth rates for all levels of dystocia in multiparous cows. Among multiparous cows needing assistance (dystocia 3+), stillbirth rates were greatest for shorter gestations less than the average of 280 d, 55.3% for -15 to -12 d, 45.5% for -11 to -9 d, 33.7% for -8 to -5 d, 23.8% for -4 to 13 d, and 35.4% for 14 to 15 d. Gestation length pinpointed the time when stillbirths occurred, as indicated by the increase from 23.8% stillbirth rate among calves born at or above the mean gestation length to 55.3% for those calves born -15 to -12 d below the mean gestation. Further investigation of the relationship between stillbirth rates and gestation length is needed to develop a more complete understanding of the biological processes resulting in the loss of calves at birth.     

Induction of human breast cancer cell apoptosis from G2/M preceded by stimulation into the cell cycle by Z-1,1-dichloro-2,3-diphenylcyclopropane

We have shown previously that Z-1,1-dichloro-2,3-diphenylcyclopropane (a.k.a. Analog II, A(II)) inhibits human breast cancer cell proliferation regardless of estrogen receptor status or estrogen sensitivity, and that its cellular targets include microtubules. In the present study, we investigated the apoptosis-inducing effects of A(II). MCF-7, MCF-7/LY2, and MDA-MB-231 cells all showed nuclear fragmentation in response to 100 microM A(II) when stained with Hoechst 33342 and examined by fluorescence microscopy. Pulsed field gel electrophoretic analysis showed that each of the cell lines also developed specific high molecular weight DNA fragments: a low level of 1-2 Mb fragments appeared after 6 hr, while 30-50 kb fragments accumulated subsequently. At 24 hr of drug exposure, the majority of cells became nonadherent, and the 30-50 kb fragments were restricted to detached MCF-7 and MDA-MB-231 cells. Both adherent and detached MCF-7/LY2 cells exhibited these fragments. A previous study by single-color (propidium) flow cytometry demonstrated that A(II) blocks MDA-MB-231 cells in G2/M of the cell cycle. More refined analyses in the present study showed this same result for MDA-MB-231 cells, but MCF-7 and MCF-7/LY2 cells did not reveal apparent drug-induced cell cycle block. A(II) demonstrated growth inhibitory, cell cycle-perturbing, and hypodiploidy-inducing activity against other human breast carcinoma lines, i.e. BT-20, CAMA-1, and SKBR-3, but no such actions in the non-tumorigenic, "normal" human breast epithelial line MCF-10A. Bromodeoxyuridine labeling and two-color flow cytometric analysis, however, suggested that A(II) caused stimulation into S phase, and that G2/M was the phase of the cell cycle from which cells apoptosed. A(II) caused cell rounding, detachment from the growth matrix, and nuclear shrinkage and fragmentation in parallel with biochemical changes. Cycloheximide inhibited A(II)-induced cell death, indicating that its toxicity requires de novo protein synthesis.