Main Causes Of Impairment Research Articles

Clinical practice guidelines for diagnostic and treatment of the chronic heart failure.

Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.

Epigenetic perspective on atherosclerotic cardiovascular diseases: The holistic principle of systems biology and epigenetic reasoning

Atherosclerosis and coronary artery disease are the main causes of impairment and cardiac death, placing a significant burden on our health-care system. This review focuses on elucidating the involvement of various epigenetic mechanisms in the genesis and progression of cardiovascular diseases (CVDs), particularly chronic CVDs. The deregulation of epigenetic mechanisms plays a crucial role in the progression of CVDs, prompting exploration into novel preventive approaches. Advancements in molecular procedures, network-based approaches, and data analysis have identified new targets in CVDs, permitting the utilization of individualized epigenetic factors for personalized diagnosis and treatment. While promising for improving diagnostic and prognostic assessments, the clinical implementation of epigenetic biomarkers lags behind. Multicenter clinical documentation in a large sample population is crucial to confidently ascertain the clinical utility of specific epigenetic biomarkers. Of particular interest is the interplay between epigenetics and the conflict between the gene-based reductionist theory and the holistic principle of systems biology (SB). The holistic principle analyzes the structural organization and regulation of biological networks, influencing the genesis and progression of complex cardiac diseases like CVDs. This review emphasizes the complexity of CVDs, elucidates the interrelationship between disease networks and epigenetic mechanisms, and highlights the importance of the holistic principle of SB, coupled with artificial intelligence, in clarifying this interrelationship. The constant and uninterrupted epigenetic impact holds immense potential for advancing our understanding of disease progression and treatment across cells and tissues. Despite these advancements, the full integration of the epigenetic impact into medical practice remains incomplete, with limited utilization in clinical applications. Nevertheless, it is likely that in the near future, the epigenetic regulation of gene expression, with its lifelong and extended effects on health, will become an integral part of everyday clinical practice.

An Assessment of Dementia Knowledge and Its Associated Factors Among Health College Students in Saudi Arabia.

Background Dementia is a public health concern and the main cause of impairment and dependency among the elderly worldwide. It is characterized by a progressive decline in cognition, memory, and all domains of quality of life with preserving the level of consciousness. Accurate measurement of dementia knowledge among future health professionals is required to improve targeted educational initiatives and supportive care of patients. This study aimed to assess knowledge of dementia and its associated factors among health college students in Saudi Arabia. Methods A descriptive, cross-sectional study was conducted among health college students from various regions in Saudi Arabia. Data on sociodemographic characteristics and dementia knowledge were gathered using a standardized study questionnaire Dementia Knowledge Assessment Scale (DKAS) distributed on different social media platforms. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA) statistical software. A P-value of <0.05 was considered significant. Results A total of 1,613 participants were included in the study. The mean age was 20.5 ± 2.5 years (range 18-25years). The majority of them were males (64.9%), and females represented 35.1%. The mean knowledge score of the participants was 13.68 ± 3.18 (out of 25). According to DKAS subscales, we found that the respondents scored the highest in care considerations (4.17 ± 1.30) and the lowest in risks and health promotion (2.89 ± 1.96). Furthermore, we found that the participants with no previous dementia exposure had a significantly higher level of knowledge than those with previous dementia exposure. In addition, we found that both genders, aged 19, 21, 22, 23, 24, and 25 years; the geographic distribution of respondents; and previous dementia exposure significantly affected the DKAS score. Conclusions Our findings showed that health college students in Saudi Arabia had poor knowledge about dementia. Ongoing health education and comprehensive academic training are recommended to improve their knowledge and provide competent care for dementia patients.

The Risk Factors Effect of Knee Osteoarthritis Towards Postural Lateral Sway

Background: Osteoarthritis (OA) is the main cause of impairment and disability in elderly. Patient with OA experience progressive functional impairment shown in increasing dependence on walking, using stairs and etc. Patients with OA experience increased static postural sway in the lateral and anteroposterior due to several factors. Objective: This study aims to analize the risk factors of knee osteoarthritis on postural lateral sway. Method: This research is a cross sectional study. The severity of the respondents’ knee OA, unilateral/ bilateral, dominant side, knee joint alignment, body mass index (BMI), and postural lateral sway were measured with Gait Analyzer Peak Motus 2000, and their quadriceps muscle activity was assessed with Myomed. Respondents involved in this study were 38 elderly with unilateral or bilateral knee OA stage 1 until 3 based on the criteria of Kellgren &amp; Lawrence. The data were analyzed with multiple linear regression. Results: The results showed that postural lateral sway was 2.23+0.59 cm. BMI, dominant side, OA types, OA severity, Quadriceps angle, and tibio-fibular angle (TFA) were found with the p value = 0.421, 0.599, 0.780, 0.913, 0.596, and 0.984 respectively. The Visual Analogue Scale (VAS) variable was R Square = 0.291, p = 0.001, Y = 0.3096 and X = 0.9393. Conclusion: Pain is the strongest predictor factor of postural lateral sway disturbances in patients with knee OA.

P194 Risk factors of axial spondyloarthritis among inflammatory bowel disease patients

Abstract Background Spondyloarthritis (SpA) is the most common extraintestinal manifestation (EIM) in inflammatory bowel disease (IBD) patients. However, the delay for the diagnosis of SpA in IBD patients is still unacceptably long, and may be the main cause of impairment due to ankylosing spondylitis. The aim of this study was to identify predictors of axial SpA in IBD patients, in order to prevent complications. Methods We conducted a retrospective study between 2001 and 2018 including all IBD patients diagnosed with symptomatic axial Spondyloarthritis (SpA) (Group1) and non-SpA patients among IBD (Group2). Diagnosis of SpA was based on ASAS 2009 criteria and confirmed by rheumatologists. Medical data were collected then uni and multivariate statistical analysis (p significant if ≤0.05) were performed. Results Seventy-eight patients with mean age 38 ± 11 years and sex ratio H/F = 1.6 were included. There were 58 (74.4%) Crohn’s disease (CD) patients and twenty patients (25.6%) had ulcerative colitis (UC). The average duration of IBD in all patients was 89.7 ± 69.1 months. SpA group included 26 patients (33.3%), six of whom (23%) had a late-stage disease (ankylosis). Most of the SpA patients (53.8%) had their disease before IBD onset with an average delay of 52.5 ± 68 months between SpA diagnosis and IBD symptoms. In univariate analysis, factors associated with SpA in IBD patients were familial history of IBD (p = 0.025) and the type of IBD (39.7% in CD vs. 15% in UC; p = 0.04). Among CD patients’, structuring-type was significantly associated with SpA (p = 0.04). Multivariate analysis showed that familial history of IBD (OR = 0.17; IC95%; 0.03–0.93; p = 0.04) and CD (OR = 3.72; IC 95%; 0.98–14.15; p = 0.05) were independent risk factors of axial SpA during IBD. EIMs other than SpA were more frequent in group 1 than in group 2 such as peripheral arthropathies (19.2% vs. 8.3% respectively; p = 0.02), anterior uveitis (11.5% vs. 0% respectively; p = 0.01) and erythema nodosum (7.7% vs. 0% respectively; p = 0.04). Conclusion In conclusion, predictors of symptomatic axial SpA were familial history of IBD and CD with structuring behaviour. Early-stage diagnosis is important to avoid ankylosis, which is a major cause of handicap in younger patients.

Factors That Contribute to the Use of Stroke Self-Rehabilitation Technologies: A Review

BackgroundStroke is increasingly one of the main causes of impairment and disability. Contextual and empirical evidence demonstrate that, mainly due to service delivery constraints, but also due to a move toward personalized health care in the comfort of patients’ homes, more stroke survivors undergo rehabilitation at home with minimal or no supervision. Due to this trend toward telerehabilitation, systems for stroke patient self-rehabilitation have become increasingly popular, with many solutions recently proposed based on technological advances in sensing, machine learning, and visualization. However, by targeting generic patient profiles, these systems often do not provide adequate rehabilitation service, as they are not tailored to specific patients’ needs.ObjectiveOur objective was to review state-of-the-art home rehabilitation systems and discuss their effectiveness from a patient-centric perspective. We aimed to analyze engagement enhancement of self-rehabilitation systems, as well as motivation, to identify the challenges in technology uptake.MethodsWe performed a systematic literature search with 307,550 results. Then, through a narrative review, we selected 96 sources of existing home rehabilitation systems and we conducted a critical analysis. Based on the critical analysis, we formulated new criteria to be used when designing future solutions, addressing the need for increased patient involvement and individualism. We categorized the criteria based on (1) motivation, (2) acceptance, and (3) technological aspects affecting the incorporation of the technology in practice. We categorized all reviewed systems based on whether they successfully met each of the proposed criteria.ResultsThe criteria we identified were nonintrusive, nonwearable, motivation and engagement enhancing, individualized, supporting daily activities, cost-effective, simple, and transferable. We also examined the motivation method, suitability for elderly patients, and intended use as supplementary criteria. Through the detailed literature review and comparative analysis, we found no system reported in the literature that addressed all the set criteria. Most systems successfully addressed a subset of the criteria, but none successfully addressed all set goals of the ideal self-rehabilitation system for home use.ConclusionsWe identified a gap in the state-of-the-art in telerehabilitation and propose a set of criteria for a novel patient-centric system to enhance patient engagement and motivation and deliver better self-rehabilitation commitment.

αIIb(R990W), a Gain-of Function Mutation of αIIbβ3, Knock-in Mice Show Moderately Impaired Thrombopoiesis

Introduction:Integrin αIIbβ3 plays an essential role in platelet aggregation, and quantitative or qualitative defects in αIIbβ3 lead to severe bleeding diathesis, which is known as Glanzmann thrombasthenia (GT). Although platelet counts and morphology are usually normal in GT patients, recent several reports demonstrate that constitutive gain-of-function mutations around transmembrane regions of αIIb or β3 are associated with congenital macrothrombocytopenia, which is referred to as αIIbβ3-related thrombocytopenia. αIIb(R995W) is the most prevalent mutation in αIIbβ3-related thrombocytopenia among Japanese (Kunishima, Kashiwagi, et al. Blood. 2011;117:5479-84). We also found reduction of surface expression of αIIbβ3 on platelets in patients with αIIbβ3-rerated thrombocytopenia, suggesting that activating mutations may affect platelet function via not only activating state of αIIbβ3 but also its expression (Kashiwagi, et al. Mol Genet Genomic Med. 2013;1:77-86). However, the pathogenesis of thrombocytopenia caused by αIIbβ3 gain-of-function mutations is not fully understood. We have generated αIIb(R990W), which is corresponding to human αIIb(R995W), knock-in (KI) mice and previously reported that αIIb(R990W) KI mice showed mild macrothrombocytopenia and Homo KI mice revealed marked reduction of surface αIIbβ3 expression in platelet and impaired platelet function like GT (ASH meeting 2014). In this study, we further analyzed αIIb(R990W) KI mice to elucidate the mechanism causing macrothrombocytopenia.Methods:αIIb(R990W) mutation was introduced to C57BL/6-derived ES cells by homologous recombination and KI mice were generated. Reticulated platelets were detected by flow cytometry after thiazole orange staining. Serum thrombopoietin (TPO) levels were measured by ELISA. Platelet life span was assessed by flow cytometry after injection with NHS-biotin. Platelet counts and reticulated platelets were monitored after injection of murine TPO or anti-GPIb antibody. We counted megakaryocytes (MgK) in tissue preparation of femur and spleen. MgK ploidy was analyzed by flow cytometry. We analyzed proplatelet formation (PPF) of cultured fetal liver cells from embryonic day 14.5 embryos.Results:Platelet counts were decreased in KI mice [WT: 1.22 ± 0.11 (x106/μL), Hetero: 1.10 ± 0.14*, Homo: 0.91 ± 0.11* (*p<0.05 compared with WT)]. Absolute reticulated platelet numbers were significantly decreased in Homo mice compared with WT [WT: 102 ± 21.9 (x103/μL), Hetero: 84.0 ± 23.7, Homo: 66.6 ± 12.3* (*p<0.05 compared with WT)]. Although serum TPO level tended to be high in Homo mice [WT: 374 ± 155 (pg/mL), hetero: 380 ± 83, homo: 430 ±283], there were no statistically significant differences. Platelet increase after TPO injection was significantly delayed and peak platelet counts were lower in Homo mice compared to WT and Hetero mice. Recovery from anti-GPIb antibody induced thrombocytopenia was mildly impaired on 4 days after injection in KI mice. These results suggest that platelet production is impaired in KI mice. In addition, the half-life of platelets was slightly but significantly shortened in KI mice compared with WT [WT: 28.99 ± 1.76 (hours), Hetero: 24.90 ± 4.73, Homo: 19.54 ± 1.01* (*p<0.05 compared with WT)], which may also contribute to thrombocytopenia in KI mice. Between Homo mice and WT, there was no difference in the number of MgK in femur bone marrow [WT: 68.7 ± 5.04 (/10 visual fields), Homo: 75.7 ± 6.74] and spleen [WT: 24.7 ± 5.21 (/slide), Homo: 28.3 ± 5.55]. MgK ploidy in KI mice were similar to WT. However, PPF of MgK derived from fetal liver cells was significantly decreased in Homo mice [WT: 24.94 ± 3.11 (%), hetero: 22.21 ± 1.55, homo: 15.65 ± 1.49* (*p<0.05 compared with WT)].Conclusion:Our results suggest that the αIIbβ3 gain-of-function mutation, αIIb(R990W), leads to thrombocytopenia via mainly impaired thrombopoiesis. There was no difference in number and ploidy of MgK. However, Homo KI mice show marked reduction of PPF, indicating impaired proplatelet formation appears to be a main cause of impairment of thrombopoiesis by the mutation.Disclosures:No relevant conflicts of interest to declare. DisclosuresKanakura:Alexion Pharmaceuticals, Inc.: Consultancy, Honoraria, Research Funding. Tomiyama:Kyowa Hakko Kirin Co., Ltd.: Honoraria; Chugai Pharmaceutical Co., Ltd.: Honoraria; Novartis Pharma Co., Ltd.: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sysmex Corporation: Consultancy.

Fully Automatic Finger Extensor Tendon Segmentation in Ultrasound Images of the Metacarpophalangeal Joint.

In this work a fully automatic system to identify the extensor tendon on ultrasound images of the metacarpophalangeal joint is proposed. These images are used to diagnose rheumatic diseases which are one of the main causes of impairment and pain in developed countries. The early diagnosis of these conditions is crucial to a proper treatment and follow-up and so, a system such as the one proposed here, could be useful to automatically extract relevant information from the resulting images. This work is an extension of a previous published work which uses manual annotations of the skin line, metacarpus and phalange to guide the extensor tendon segmentation. By introducing automatic segmentations of all structures, we expect to create a fully automatic system, which is more interesting to the possible end-users. Results show that, despite an expected loss in the performance, it is still possible to correctly identify the extensor tendon with a Confidence of 88% considering a maximum allowed Modified Hausdorff Distance of 0.5mm.

DRUG FACTORS INFLUENCING ITS USE AMONG UNDERGRADUATE STUDENTS OF A TERTIARY INSTITUTION IN NIGERIA

OBJECTIVE: Drug use and abuse have been reported to be one of the main causes of impairment of social competence and performance among students. Also, school drop out, criminal tendencies and poor social interaction have also been reported to be associated with drug abuse among these students. Knowing the Prevalence and patterns of drug use, number of drug use, reason for use, sustainability and duration of drug used as drug factors will help in primary prevention strategy in tertiary institutions in Nigeria and globally.METHODS: A descriptive cross sectional study involving four hundred and forty (440) subjects selected through multistage sampling techniques. All the subjects consented and participated in the study. Self administered socio demographic, WHO students’ drug use and drug factors influencing use questionnaires were administered to the subjects to fill through their class representative. Statistical package for social science (SPSS) 15th editions was used in Data analysis. RESULTS:Four hundred and forty (440) students drawn from 3 faculties of the university participated in the study. One hundred and fifty (150) respondents constituting 34.1% were from faculty of Engineering, one hundred and fifteen (115) respondents constituting 26.1% were from faculty of Education while one hundred and seventy five (175) respondents constituting about 39.8% were from college of Medicine. One hundred and thirteen subjects (25.7%) used one and more of all the 10 drugs examined by the questionnaires. Duration of tobacco use revealed that 40 had used it 5years and above, 15 used it between 3-5years, 4 used it between 6months-1year while 2 tobacco users had 1-3years as duration of usage. The differences was statistically significance (df =4, x2= 12.07, p=0.01). All the 6 cocaine users(1.4%) take 3 other drugs alongside cocaine. The difference was also statistically significant (df= 3, x2= 26.21, p=0.00). Multiple drug use of 3 and more was found to be significant with many of the drugs examined.CONCLUSIONS: Prevalence, patterns and drug factors revealed that psychoactive drug use was found among students of Ahmadu Bello University Zaria like in other institutions of higher learning in Nigeria. Appropriate interventions like health education, social support system, counseling, referral systems, parental supervision and enforcement of necessary laws by regulatory agencies were some of the recommendations to curb the menace in our institutions in Nigeria.

Eye Accidents In The Work Environment Of Health: An Integrative Review

It is an integrative literature review with the objective of integrating the knowledge produced about eye accidents in the work environment of health, pointing out the main causes of impairment of visual acuity and protective factors. Five databases were consulted to select the articles - SCOPUS, CINAHL, PubMed, LILACS and Web of Science - which included six articles. The results show that the studies were conducted between 2005 and 2013. The eye accidents were grouped into three categories: the cause of the eye accident, post-accident management, and protection factor. It is concluded that non-adherence to eye protection measures is an important factor in accidents involving the eye, which makes rethink the security policies implemented by health institutions with an emphasis on visual apparatus.

Effect of oxygenation and temperature on glucose-xylose fermentation in Kluyveromyces marxianus CBS712 strain

BackgroundThe yeast Kluyveromyces marxianus features specific traits that render it attractive for industrial applications. These include production of ethanol which, together with thermotolerance and the ability to grow with a high specific growth rate on a wide range of substrates, could make it an alternative to Saccharomyces cerevisiae as an ethanol producer. However, its ability to co-ferment C5 and C6 sugars under oxygen-limited conditions is far from being fully characterized.ResultsIn the present study, K. marxianus CBS712 strain was cultivated in defined medium with glucose and xylose as carbon source. Ethanol fermentation and sugar consumption of CBS712 were investigated under different oxygen supplies (1.75%, 11.00% and 20.95% of O2) and different temperatures (30°C and 41°C). By decreasing oxygen supply, independently from the temperature, both biomass production as well as sugar utilization rate were progressively reduced. In all the tested conditions xylose consumption followed glucose exhaustion. Therefore, xylose metabolism was mainly affected by oxygen depletion. Loss in cell viability cannot explain the decrease in sugar consumption rates, as demonstrated by single cell analyses, while cofactor imbalance is commonly considered as the main cause of impairment of the xylose reductase (KmXR) - xylitol dehydrogenase (KmXDH) pathway. Remarkably, when these enzyme activities were assayed in vitro, a significant decrease was observed together with oxygen depletion, not ascribed to reduced transcription of the corresponding genes.ConclusionsIn the present study both oxygen supply and temperature were shown to be key parameters affecting the fermentation capability of sugars in the K. marxianus CBS712 strain. In particular, a direct correlation was observed between the decreased efficiency to consume xylose with the reduced specific activity of the two main enzymes (KmXR and KmXDH) involved in its catabolism. These data suggest that, in addition to the impairment of the oxidoreductive pathway being determined by the cofactor imbalance, post-transcriptional and/or post-translational regulation of the pathway enzymes contributes to the efficiency of xylose catabolism in micro-aerobic conditions. Overall, the presented work provides novel information on the fermentation capability of the CBS712 strain that is currently considered as the reference strain of the genus K. marxianus.

Teorías subjetivas de profesionales de escuelas de lenguaje en chile sobre el trastorno específico del lenguaje

OBJETIVO: comprender y reconstruir las teorías subjetivas de profesionales de escuelas de lenguaje en Chile, sobre las causas y el tratamiento del trastorno específico del lenguaje. MÉTODO: se utilizó métodos cualitativos para recolectar datos en profundidad. Se realizó entrevistas individuales semi-estructuradas con una muestra de cuatro fonoaudiólogas (logopedas) y cuatro educadoras diferenciales de cuatro escuelas de lenguaje. Se grabó y transcribió las entrevistas, las que fueron analizadas con el programa informático Atlas.ti 5.0. Los resultados del análisis relacional se sintetizaron en tres modelos. RESULTADOS: para las fonoaudiólogas y educadoras diferenciales las causas principales del trastorno específico del lenguaje son factores sociales, originados en la familia de los niños afectados. Con respeto a la superación de este trastorno las entrevistadas destacaron con alta importancia el apoyo familiar para un tratamiento eficaz. CONCLUSIONES: entre las explicaciones subjetivas de las profesionales entrevistadas y las explicaciones científicas acerca las causas del trastorno específico del lenguaje, existen diferencias. Mientras las entrevistadas hablan de causas sociales, los enfoques científicos explican este trastorno por causas biológicas. Esta diferencia debería ser investigada en estudios posteriores. Las fonoaudiólogas y educadoras diferenciales ven la familia del niño como una de las causas principales del trastorno específico del lenguaje y al mismo tiempo consideran el apoyo familiar como un requisito crucial en el tratamiento. En la opinión de los profesionales de las escuelas de lenguaje el trastorno específico del lenguaje es un trastorno superable, si escuela y familia trabajan en conjunto.

Mycophenolic acid affects basic functions of human keratinocytes in the IMPDH-dependent manner

Clinical studies suggest that the immunosuppressant MPA is associated with impaired wound healing. It is believed that the main cause of impairment is the inhibition of inflammatory response. However, it is unknown whether MPA may directly affect epidermal cells. The aim of our study was to examine the direct influence of mycophenolic acid, the selective blocker of de novo purine synthesis, on human epidermal keratinocyte morphology, proliferation, motile activity, and differentiation in in vitro culture. The number of keratinocytes cultured in the presence of MPA was counted and cell motility was measured by a time-lapse computer-aided method. Cell morphology was determined by flow and image cytometry methods. Real-time RT-PCR analysis was employed to investigate the expression of markers of differentiation. We showed that MPA induces irreversible inhibition of cell proliferation, causes cell enlargement and impairs cell locomotion in a time-dependent manner. The level of expression of differentiation markers was significantly reduced by MPA treatment. All these effects were reversed by the addition of guanine. Our results indicated that MPA impairs basic functions of human skin keratinocytes via intracellular guanosine nucleotide depletion, which may be directly reflected in wound healing problems in patients treated with this immunosuppressant.

Carpal tunnel syndrome in fibromyalgia patients – A crucial factor for their functional impairment

Fibromyalgia (FM) is a diffuse, chronic pain syndrome associated with tender body areas and somatic complaints. A high prevalence of undetected carpal tunnel syndrome (CTS) in patients with FM has been reported and it seems to affect their functional level. The aim of the workThis study was designed to compare between the presence of CTS in FM patients and control subjects and to find out if the severity of CTS is correlated with the functional impairment questionnaire (FIQ) score. Patients & methodsThe study was carried out on 100 females, divided into two groups: 40 patients with fibromyalgia, their ages ranged from 20 to 45years and 60 healthy controls, their ages ranged from 20 to 42years. All subjects were subjected to full history taking, full locomotor examination, calculation of body mass index (BMI) and electrodiagnosis for CTS. Patients were asked to complete the FIQ. ResultsFM patients had a significantly higher frequency of CTS as compared to the control group. Moderate CTS was more frequent among the patients. There was a highly statistically significant correlation between the severity of CTS and the FIQ score. Also there was a highly statistically significant difference as regards the FIQ score between the two subgroups of patients. ConclusionCTS is more frequent in patients with FM than the normal population. Correlations between the severity of CTS and the FIQ score prove that CTS is one of the main causes of impairment in patients with FM.

Chemical and Geological Control on Surface Water within the Shade River Watershed in Southeastern Ohio

The under-sampled middle and western branches of Shade River Watershed (SRW) in SE Ohio were investigated as part of the Ohio University—U.S. Environmental Protection Agency (EPA) STAR grant. This project was for monitoring the quality of watersheds in Ohio and classifying them according to their physical, chemical, and biological conditions. Water samples, as well as field parameters, were taken at twenty-two sites for chemical analyses. The ions analyzed included Ca, Mg, Na, Fe, Mn, Al, NO3, SO4, HCO3, and total PO4, while the field parameters measured included pH, dissolved oxygen (DO), total dissolved solids (TDS), electrical conductivity (EC), and alkalinity. To assess the water quality within the SRW, the analyzed ions and field parameters were compared to the USEPA criteria for the survival of aquatic life. Analytical results showed that the watershed is dominated by Ca-HCO3waters with DO, Fe, Mn, and PO4being the main causes of impairment within the streams. The relatively elevated concentrations of manganese and less extent iron may be associated with the local geology and the acidic nature of the soils. The high alkalinity and calcium concentrations are due to the limestone geology. The elevated phosphate concentration may be due to anthropogenic sources, fertilizers, or contributions from phosphorus-rich bedrock that differs geochemically from other areas.

On time diversity for packet channels

Packet losses and delays represent two of the main causes of impairment on packet-based communications. Recent proposals for robust and efficient transmission suggest joint design of coding and routing strategies. This paper introduces a general framework to analyze time diversity in packet-based communications. An algorithm for designing an efficient distribution of information in multiple packets that takes into account for both losses and delays is presented. Simulation results show in which cases time diversity may have a positive impact on various applications.

Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work.

To provide a detailed description of post-herniorrhaphy convalescence. Prospective, descriptive, consecutive questionnaire case series. Public university hospital, Denmark. 100 consecutive patients treated for inguinal hernia. Elective open inguinal herniorrhaphy under local anaesthesia. One day convalescence for light/moderate and three weeks for strenuous physical activity was recommended. Duration of absence from work or main recreational activity. Overall median absence (including the day of operation) was 6 days (interquartile range 1-16). For unemployed patients it was 1 day (0-7), for patients with a light or moderate workload 6 days (3-12), and for those with a heavy workload 25 days (21-37). Among the 64 patients, who did not follow the recommendations, pain was contributory in 33 and advice from the general practitioner in 12. Pain was the main cause of impairment of activities of daily living. Well-defined recommendations for convalescence may, together with improved management of postoperative pain, shorten convalescence; they are essential in the evaluation of effects of different surgical techniques of herniorrhaphy on convalescence.

Revision of the first web space: technics and results.

Between 1975 and 1980, 91 patients in our series with involvement of 103 webs had revision of a contracted first web space. The five main causes of impairment were burns, trauma, congenital defects, cerebral palsy, and cerebrovascular accident. Technics used were simple Z-plasty; four-flap Z-plasty; modified double-opposing Z-plasty; and rotational flaps from the dorsum of the thumb, index finger, or hand. No pedicled, tubed, or distant flaps were needed. Simple Z-plasty was sufficient for increases to 1 cm; for greater increases a modified double-opposing Z-plasty or local rotational flap was necessary. The modified double-opposing Z gave excellent depth. Release of all contracting elements and addition of sufficient supple skin to the web are required for success.

RESULTS OF THE CLINICAL EXAMINATIONS OF PUPILS WITH IMPAIRMENT OF HEARING IN THE PRIMARY SCHOOLS IN OSAKA CITY

Pupils with impairment of hearing in the primary schools in Osaka City were examined and results obtained were as follows. (1) By screening test with audiometer or by the hearing test with whispering method, 1, 098 pupils with impairment of hearing out of 50, 496 persons (2.2percent) were found. (2) After the screening test of audiometer, the clinical oto-rhinological examination was carried out, and as a result 442 pupils described above out of 35, 757 persons (1.2 percent) were found. (3) In both examinations, it was recognized that the main cause of impairment of hearing was chronic medial otitis.