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Background: Transmission of coronavirus disease 2019 (COVID-19) has been demonstrated in fitness settings internationally. We report the first documented case of transmission of COVID-19 in a gymnasium in Australia in 2020., Methods: Case finding and case interviews were conducted among attendees in a Western Sydney gymnasium, Australia. Whole genome sequencing using an amplicon-based approach was performed on all SARS CoV-2 polymerase chain reaction positive samples detected through surveillance., Results: We show that five cases of COVID-19 were linked to the gymnasium, with transmission occurring on 7 July 2020, when the index case transmitted the infection to four other gymnasium attendees through the sharing of an enclosed space., Conclusions: There is an ongoing risk of transmission of COVID-19 within gymnasium environments and they are justifiably classified as a 'high-risk' venue. There may be a need to expand ventilation and space requirements to prevent transmission of COVID-19 in such settings in the context of severe COVID-19 variants or to prevent respiratory disease transmission in general., (© Commonwealth of Australia CC BY-NC-ND)

Lyme disease, caused primarily in North America by the bacterium Borrelia burgdorferi sensu stricto, is the most frequently reported vector-borne disease in North America and its geographic extent is increasing in all directions from foci in the northeastern and north central United States. Several southeastern states, including Virginia and North Carolina, have experienced large increases in Lyme disease incidence in the past two decades, with the biggest changes in incidence occurring in the western portion of each state. We tested the hypothesis that B. burgdorferi s.s. was present in western Virginia and North Carolina Peromyscus leucopus populations prior to the recent emergence of Lyme disease. Specifically, we examined archived P. leucopus museum specimens, sampled between 1900 and 2000, for B. burgdorferi s.s. DNA. After confirming viability of DNA extracted from ear punch biopsies from P. leucopus study skins collected between 1945 and 2000 in 19 Virginia counties and 17 North Carolina counties, we used qPCR of two species-specific loci to test for the presence of B. burgdorferi s.s. DNA. Ten mice, all collected from the Eastern Shore of Virginia in 1989, tested positive for presence of B. burgdorferi; all of the remaining 344 specimens were B. burgdorferi-negative. Our results suggest that B. burgdorferi s.s was not common in western Virginia or North Carolina prior to the emergence of Lyme disease cases in the past two decades. Rather, the emergence of Lyme disease in this region has likely been driven by the relatively recent expansion of B. burgdorferi s.s. in southward-moving ticks and reservoir hosts in the mountainous counties of these two states., (Copyright © 2022. Published by Elsevier GmbH.)

Verbal fluency is commonly used to evaluate cognitive dysfunction in a variety of neuropsychiatric diseases, yet the neurobiology underlying performance of this task is incompletely understood. Electrocorticography (ECoG) provides a unique opportunity to investigate temporal activation patterns during cognitive tasks with high spatial and temporal precision. We used ECoG to study high gamma activity (HGA) patterns in patients undergoing presurgical evaluation for intractable epilepsy as they completed an overt, free-recall verbal fluency task. We examined regions demonstrating changes in HGA during specific timeframes relative to speech onset. Early pre-speech high gamma activity was present in left frontal regions during letter fluency and in bifrontal regions during category fluency. During timeframes typically associated with word planning, a distributed network was engaged including left inferior frontal, orbitofrontal and posterior temporal regions. Peri-Rolandic activation was observed during speech onset, and there was post-speech activation in the bilateral posterior superior temporal regions. Based on these observations in the context of prior studies, we propose a model of neocortical activity patterns underlying verbal fluency., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Poor balance, lack of neuromuscular control, and movement ability are predictors of performance and injury risk in sports and physical activity participation. The Functional Movement Screen™ (FMS™) and lower quarter Y-Balance Test (YBT) have been used by clinicians to evaluate balance, functional symmetry, and static and dynamic movement patterns, yet little information exists regarding the relationship between the FMS™, YBT, and physical performance tests (e.g. vertical jump) within the high school population., Purpose: The purpose of this study was to investigate the relationship between the FMS TM , dynamic balance as measured by the YBT and physical performance tests (standing long jump, vertical jump, Pro Agility Test) in male and female high school athletes., Study Design: Cohort study., Methods: Fifty-six high school athletes (28 females, 28 males; mean age 16.4 ± 0.1) who participated in organized team sports were tested. Participants performed the FMS™, YBT, and three physical performance tests (standing long jump, vertical jump, Pro Agility Test)., Results: Females outperformed males on the FMS™ and YBT, while males outperformed females on the performance tests. In both sexes, the composite FMS TM score was positively correlated with the left and composite YBT scores. Agility was negatively correlated with composite FMS TM in males ( p  < 0.05) and the left and composite YBT in females ( p  < 0.05)., Conclusions: The FMS TM and YBT may evaluate similar underlying constructs in high school athletes, such as dynamic balance and lower extremity power. The results of this study demonstrate the utility of the FMS and YBT to relate multiple constructs of muscular power to an individual's ability to balance. Furthermore, establishing the need for the utilization and application of multiple field-based tests by sports medicine professionals and strength and conditioning coaches when evaluating an athlete's movement and physical performance capabilities. Utilization of multiple field-based tests may provide the first step for the development of injury prevention strategies and long-term athlete development programs., Level of Evidence: 2b., Competing Interests: Conflict of interest statement: The authors declare that there are not conflicts of interest., (© 2019 by the Sports Physical Therapy Section.)

Objective: To examine and describe normative values for an objective, mobile measure of postural stability commonly used in concussion assessments, SWAY Balance (SWAY Medical, Tulsa, Oklahoma)., Design: Retrospective analysis of baseline balance assessments in a healthy pediatric population., Setting: Baseline assessments completed by certified athletic trainers at an outpatient concussion center or sports medicine offices in Philadelphia, PA and surrounding suburban Pennsylvania and New Jersey or during an athletic trainer's baseline assessment of collegiate athletes at a National Collegiate Athletic Association (NCAA) Division-II University in Fort Lauderdale, FL., Participants: Test results of a sample of 466 athletes aged 5 to 18 years were included., Interventions: The SWAY Balance test was administered using a mobile device on all participants as part of a standard preseason, baseline evaluation, following the standard evaluation protocol., Main Outcome Measures: Baseline SWAY Balance mobile assessment balance and reaction time scores, age and sex effects, were examined., Results: Normative scores are described, with results stratified into 4 age groups (5-9, 10-12, 13-17, and 18 years old). Balance scores, overall and within each individual stance score, improved with the age of the participants. Sex effects on balance were only seen in single-leg stances, with females outperforming males. Reaction time was found to be faster in males and improved with age, peaking at 13 to 17 years old and slowing in 18-year-olds., Conclusions: Normative, age-specific SWAY Balance test results provided are of clinical use as references in the concussion assessments of pediatric athletes.

Background: The complex clinical presentation and progression of Lennox-Gastaut syndrome (LGS) can complicate the accurate diagnosis of this severe, lifelong, childhood-onset epilepsy, often resulting in suboptimal treatment. The Refractory Epilepsy Screening Tool for LGS (REST-LGS) was developed to improve the identification of patients with LGS., Methods: Using the Modified Delphi Consensus, a group of experts developed and tested the REST-LGS Case Report Form (CRF) comprising 8 criteria (4 major, 4 minor) considered potentially indicative of LGS. Diagnosis-blinded specialist and nonspecialist raters at 2 epilepsy centers applied the CRF to deidentified patient records, including 1:1 records of patients with drug-resistant epilepsy or confirmed LGS. Interrater reliability was measured by Cohen's κ. Diagnosis was then unblinded to reveal common criteria for LGS or drug-resistant epilepsy. Cronbach's α was used to measure internal consistency between raters for all criteria combined., Results: Of 200 patients, 81% to 85% met 1 to 3 major criteria. At both sites, moderate (κ, 0.41-0.60) to good (κ, 0.61-0.80) agreement on most criteria was reached between expert and nonexpert raters. Unblinding revealed that most patients with LGS met 3 major and 2 to 3 minor criteria, while patients with drug-resistant epilepsy met ≤1 major and only 1 to 2 minor criteria. Cronbach's α of raters at both sites was 0.64., Conclusions: The combined number of major/minor criteria on the CRF may be particularly indicative of LGS. Therefore, the REST-LGS may be a valuable clinical tool in identifying patients requiring further diagnostic evaluation for LGS., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To present a method for simultaneous acquisition of alveolar oxygen tension (P A O 2 ), specific ventilation (SV), and apparent diffusion coefficient (ADC) of hyperpolarized (HP) gas in the human lung, allowing reinterpretation of the P A O 2 and SV maps to produce a map of oxygen uptake (R)., Method: An imaging scheme was designed with a series of identical normoxic HP gas wash-in breaths to measure ADC, SV, P A O 2 , and R in less than 2 min. Signal dynamics were fit to an iterative recursive model that regionally solved for these parameters. This measurement was successfully performed in 12 subjects classified in three healthy, smoker, and chronic obstructive pulmonary disease (COPD) cohorts., Results: The overall whole lung ADC, SV, P A O 2 , and R in healthy, smoker, and COPD subjects was 0.20 ± 0.03 cm 2 /s, 0.39 ± 0.06,113 ± 2 Torr, and 1.55 ± 0.35 Torr/s, respectively, in healthy subjects; 0.21 ± 0.03 cm 2 /s, 0.33 ± 0.06, 115.9 ± 4 Torr, and 0.97 ± 0.2 Torr/s, respectively, in smokers; and 0.25 ± 0.06 cm 2 /s, 0.23 ± 0.08, 114.8 ± 6.0Torr, and 0.94 ± 0.12 Torr/s, respectively, in subjects with COPD. Hetrogeneity of SV, P A O 2 , and R were indicators of both smoking-related changes and disease, and the severity of the disease correlated with the degree of this heterogeneity. Subjects with symptoms showed reduced oxygen uptake and specific ventilation., Conclusion: High-resolution, nearly coregistered and quantitative measures of lung function and structure were obtained with less than 1 L of HP gas. This hybrid multibreath technique produced measures of lung function that revealed clear differences among the cohorts and subjects and were confirmed by correlations with global lung measurements. Magn Reson Med 78:611-624, 2017. © 2016 International Society for Magnetic Resonance in Medicine., (© 2016 International Society for Magnetic Resonance in Medicine.)

Background and Purpose: Nurses' attitudes play an important role in the consistent practice of safe patient handling behaviors. The purposes of this study were to develop and assess the psychometric properties of a newly developed instrument measuring attitudes of nurses related to the care and safe handling of patients who are obese., Methods: Phases of instrument development included (a) item generation, (b) content validity assessment, (c) reliability assessment, (d) cognitive interviewing, and (e) construct validity assessment through factor analysis., Results: The final data from the exploratory factor analysis produced a 26-item multidimensional instrument that contains 9 subscales., Conclusions: Based on the factor analysis, a 26-item instrument can be used to examine nurses' attitudes regarding patients who are morbidly obese and related safe handling practices.

Context: Functional Movement Screen (FMS) scores of ≤14 have been used to predict injury in athletic populations. Movement asymmetries and poor-quality movement patterns in other functional tests have been shown to predict musculoskeletal injury (MSI). Therefore, movement asymmetry or poor-quality movement patterns on the FMS may have more utility in predicting MSI than the composite score., Objective: To determine if an asymmetry or score of 1 on an individual FMS test would predict MSI in collegiate athletes., Design: Cohort study., Setting: National Collegiate Athletic Association Division II university athletic program., Patients or Other Participants: A total of 84 Division II rowers, volleyball players, and soccer players (men: n = 20, age = 20.4 ± 1.3 years, height = 1.77 ± 0.04 m, mass = 73.5 ± 4.8 kg; women: n = 64, age = 19.1 ± 1.2 years, height = 1.69 ± 0.09 m, mass = 64.8 ± 9.4 kg)., Main Outcome Measure(s): The FMS was administered during preseason preparticipation examinations. Injury-incidence data were tracked for an academic year by each team's certified athletic trainer via computer software. An MSI was defined as physical damage to the body secondary to athletic activity or an event for which the athlete sought medical care, and resulted in modified training or required protective splitting or taping. Composite FMS scores were categorized as low (≤14) or high (>14). Pearson χ(2) analyses were used to determine if MSI could be predicted by the composite FMS score or an asymmetry or score of 1 on an individual FMS test (P < .05)., Results: Athletes with FMS scores of ≤14 were not more likely to sustain an injury than those with higher scores (relative risk = 0.68, 95% confidence interval = 0.39, 1.19; P = .15). However, athletes with an asymmetry or individual score of 1 were 2.73 times more likely to sustain an injury than those without (relative risk = 2.73, 95% confidence interval = 1.36, 5.4; P = .001)., Conclusions: Asymmetry or a low FMS individual test score was a better predictor of MSI than the composite FMS score.

Changes in many aspects of physical capacity and athletic performance have been documented through the course of a competitive season in collegiate athletes. Movement pattern quality as measured by the functional movement screen (FMS) has recently been linked to performance and injury risk. The purpose of this study was to document the changes in functional movement patterns over a competitive season. Fifty-seven National Collegiate Athletic Association Division II athletes were screened using the FMS as part of the pre and post participation examination for their competitive seasons in 2012. Composite and individual FMS test scores for the preseason and postseason were compared with identified significant changes. The scores were also analyzed for changes in the number of asymmetries present and the frequency of a score of 1 in any of the tests. There were no significant interactions in the main effects for time or sport in the composite FMS scores. However, 4 individual tests did show significant change. The deep squat (Z = -3.260, p = 0.001) and in-line lunge scores (Z = -3.498, p < 0.001) improved across all athletes, and the active straight leg raise (Z = -2.496, p = 0.013) and rotary stability scores (Z = -2.530, p = 0.011) worsened across all athletes. A reduction in the number of asymmetries (χ = 4.258, p = 0.039) and scores of 1 (χ = 26.148, p < 0.001) were also found. Changes in individual fundamental movement patterns occur through the course of a competitive season.

Purpose: The pilot study purpose was to determine the effects of a new standardized oral care protocol (intervention) to usual care practices (control) in poststroke patients., Design: This study is a randomized controlled clinical trial., Method: Fifty-one subjects were enrolled. Subjects in the intervention group received oral care twice a day including tooth brushing, tongue brushing, flossing, mouth rinse, and lip care while control patients received usual oral care., Findings: Subjects in the control and intervention groups showed improvement in their oral health assessments, swallowing abilities and oral intake. There were no significant differences between the two groups. Although not statistically significant, overall prevalence of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus colonization in the control group almost doubled (from 4.8% to 9.5%), while colonization in the intervention group decreased (from 20.8% to 16.7%)., Conclusions/clinical Relevance: These findings demonstrate the importance of oral care in the poststroke patient with dysphagia., (© 2014 Association of Rehabilitation Nurses.)

Purpose/background: Side to side asymmetry in glenohumeral joint rotation correlates with injury risk in overhead athletes. The purpose of the current study was to identify the relationship between side-to-side asymmetries in glenohumeral joint total rotational range of motion and shoulder mobility test scores from the Functional Movement Screen™ in collegiate overhead athletes. The authors hypothesized that asymmetries of > 10° in glenohumeral total rotation would not be associated with asymmetrical findings in the Functional Movement Screen™ (FMS) shoulder mobility test., Methods: Passive glenohumeral total rotational range of motion and the shoulder mobility test of the FMS were measured during pre-participation examinations in 121 NCAA male and female Division II collegiate overhead athletes from varied sports. Passive shoulder range of motion was measured in supine at 90° of abduction, with the humerus in the scapular plane using two measurers and a bubble goniometer. A Pearson Chi-square analysis, p<.05 was used to associate the presence of asymmetries in glenohumeral joint rotation and in the FMS shoulder mobility test in each subject., Results: 40/114 (35.1%) athletes demonstrated asymmetries in total glenohumeral rotation. 45/114 (39.5%) athletes demonstrated asymmetries in the shoulder mobility test. Only 17 of the 45 subjects who demonstrated asymmetry on the shoulder mobility test also demonstrated glenohumeral joint rotation differences of > 10°. Athletes with asymmetries in rotation of > 10° were not any more likely to have asymmetries identified in the shoulder mobility test (95% CI=.555-2.658, P=.627)., Conclusions: Glenohumeral joint range of motion is one of multiple contributors to performance on the FMS shoulder mobility test, and alone, did not appear to influence results. The FMS shoulder mobility test should not be used alone as a means of identifying clinically meaningful differences of shoulder mobility in the overhead athlete. Clinicians working with overhead athletes may consider using both assessments as a complete screening tool for injury prevention measures., Level of Evidence: Level 3.

Background: Thoracoabdominal aortic aneurysm (TAAA) repairs are technically challenging. The advent of endovascular aneurysm repair in combination with visceral/renal artery bypasses has allowed for hybrid endovascular repair of these aneurysms. The purpose of this study was to evaluate whether outcomes were affected by the number of visceral/renal artery reconstructions, conduit, or gender., Methods: All patients who underwent visceral/renal bypass associated with an endovascular aortic aneurysm repair were prospectively studied in a vascular registry and retrospectively reviewed between the years 2004 and 2009. Patients undergoing standard open TAAA repair and those with aortic arch branch vessel reconstructions associated with thoracic endovascular repair were excluded from this analysis. Patients were segregated into two groups on the basis of number of vessels bypassed. Group 1 (n = 9) consisted of patients who required one or two bypasses, whereas group 2 (n = 15) consisted of patients who required three or four bypasses., Results: A total of 64 TAAA repairs were performed. In all, 22 patients with hybrid repair and aortic arch vessel reconstructions and 18 patients with open TAAA repair were excluded from this analysis. A total of 24 (38%) patients with hybrid endovascular repair were evaluated in this study. The 30-day mortality was found to be 12.5% (3/24) and the incidence of spinal cord ischemia was 8.3% (2/24). Preoperative comorbidities and American Society of Anesthesia (ASA) scores were reported to be similar between the two groups. As compared with group 2, patients in group 1 were reported to be younger (69.7 ± 10.6 vs. 76.0 ± 5.7 years [p = 0.074]), had less blood loss (1,200 ± 1,088 mL vs. 3,119 ± 2,188 mL, [p = 0.06]), required fewer blood transfusions (5.33 ± 2.31 vs. 9.09 ± 7.06 units packed red blood cells (PRBC) [p = 0.39]), and had a shorter length of stay (11.4 ± 5.6 vs. 21.9 ± 15.1 days, [p = 0.090]). There was no difference in 30-day mortality rates between the two groups. The incidence of perioperative morbidity, including bowel ischemia (11%[1/9] vs. 27% [4/15], [p = 0.39]), myocardial infarction (11% [1/9] vs. 13% [2/15], [p = 0.88]), wound infection (0% vs. 27% [4/15], [p = 0.09]), and pneumonia (11% [1/9] vs. 40% [6/15], [p = 0.14]) was found to be less in group 1 than group 2, but this difference was not significant. Patients with three or four bypasses had a significantly greater requirement for a skilled nursing facility or a rehabilitation facility after discharge (79% [11/14] vs. 29% [2/7], p = 0.026). There were no statistically significant differences in postoperative outcomes when comparing choice of conduit (autogenous or prosthetic) or gender. Results from the Cox-proportional hazards regression showed that bowel ischemia was the only postoperative complication associated with decreased survival (p = 0.037, confidence interval [0.1328-4.3075])., Conclusions: Hybrid aortic aneurysm repair carries a significant risk of patient morbidity with an acceptable mortality for patients considered to be at a high risk for standard thoracoabdominal repair. In patients requiring fewer visceral/renal reconstructions, there is a trend toward fewer postoperative complications and a significantly shorter length of stay. Moreover, there is a significantly lower need for skilled nursing facility requirements after discharge from the hospital. Bowel ischemia is associated with significantly worse outcome and better attempts at avoiding this complication and aggressive management is indicated., (Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Spinal cord tumors (SCT) are a diverse group of uncommon neoplasms that develop from tissues in and around the spinal canal. They often have an indolent onset and progression of signs and symptoms, which may include back pain, extremity weakness, sensory alterations, and bowel or bladder incontinence. The most common SCTs are located in the extramedullary space and include meningiomas and neurofibromas. Intramedullary SCTs, for example ependymomas and astrocytomas, occur less frequently. The most useful screening test for diagnosis of a SCT is enhanced magnetic resonance imaging; myelography and computed tomography also can be helpful. The majority of SCTs are amenable to surgical therapy and can be partially or completely resected. Radiation therapy is reserved for incompletely resected low-grade tumors, malignant tumors, and recurrent tumors. The rehabilitative process should be initiated early on following diagnosis, if possible, in patients with neurologic deficits to minimize long-term disability.

The purpose of this study was to determine and standardize an easy and convenient method of studying the orthodromic latencies of the medial and lateral plantar nerves for clinical purposes using conventional equipment. Forty-one able-bodied adult subjects ranging in age from 20 to 76 years were tested orthodromically to establish normal values over fixed distances. The temperatures of the feet ranged from 26C to 32C. A standard TECA bipolar surface electrode fixed in a plastic mount was placed on the posterior tibial nerve proximal to the flexor retinaculum. The medial plantar nerve was stimulated with a bipolar surface stimulator at a distance of 10, 14, and 18cm, and at the great toe. The lateral plantar nerve was stimulated at a distance of 14 and 18cm, and at the little toe. Orthodromic latencies for the medial plantar nerve for distances of 10, 14 and 18cm, and the great toe were 2.4 +/- SD 0.15msec, 3.2 +/- SD 0.26msec, 4.0 +/- SD 0.22msec, and 5.0 +/- SD 0.38msec, respectively. Lateral plantar nerve latencies for 14 and 18cm segments were 3.2 +/- SD 0.25msec and 4.0 +/- SD 0.27msec, respectively. These standard values should allow more accurate assessment of tarsal tunnel syndrome (TTS) and peripheral neuropathies because the orthodromic method involves a mixed motor and sensory nerve action potential and should be more sensitive to early changes than a pure motor nerve action potential.

The anterior interosseous nerve is a pure motor nerve supplying the flexor pollicis longus, flexor digitorum profundus to the index and middle finger, and the pronator quadratus. A relatively uncommon neuropathy of this nerve, called the anterior interosseous syndrome (AIS), sometimes occurs. This paper reports 2 cases of AIS which developed from unusual etiologies. The first patient developed AIS after some difficulty drawing blood from the cubital vein, while the second patient developed symptoms following bypass surgery involving intravenous injection in the cubital vein. Although the diagnosis of AIS can be made clinically by noting muscle weakness in the absence of sensory deficits, electrodiagnosis is helpful for confirming diagnosis and predicting prognosis.

A clinical investigation of the use of low intensity direct current (LIDC) in treating ischemic skin ulcers was conducted at the University of Missouri. The purpose of the study was to evaluate the effect of LIDC on altering the healing rate of ischemic skin ulcers. One hundred ulcers were treated with LIDC. Six of the patients had bilateral symmetrical ulcers which provided the control group. The six control ulcers were managed exactly the same as their counterpart except that LIDC was omitted. The mean healing ratio of the control ulcers was 14.7 percent per week compared to 30 percent per week of the treated counterpart. The mean healing rate of the 100 ischemic skin ulcers treated with LIDC was 28.4 percent per week. The data indicated that ischemic skin ulcers treated with the current responded with a healing rate approximately twice as fast as those ulcers that did not receive LIDC treatment. The authors concluded that the use of LIDC added an effective modality to the armamentarium of the physical therapist for the treatment of ischemic skin ulcers.

Common neurogenic causes of scapular winging are serratus anterior, trapezius and rhomboid palsy. Deformity is minimal in serratus anterior palsy (long thoracic nerve); winging is accentuated by forward elevation and pushing with outstretched arms. In trapezius palsy (spinal accessory nerve), the shoulder droops and winging is accentuated by arm abduction at the shoulder level. Rhomboid weakness (dorsal scapular nerve or C5 root) is best demonstrated by slowly lowering the arms from the forward elevated position.

Four intrinsic muscles were studied with electromyography (EMG) in asymptomatic feet in 70 individuals to ascertain the percentage having abnormal potentials (positive sharp waves and/or fibrillation potentials). The number having positive sharp waves ranged from 6(8.6%) in the 1st dorsal interosseous to 11(15.7%) in the extensor digitorum brevis. The number showing fibrillation potentials ranged from 0 for the abductor hallucis to 4(5.7%) for the abductor digiti minimi. The authors concluded that using positive sharp waves as a diagnostic criterion in using EMG of intrinsic foot muscles in the evaluation of certain neuromuscular problems such as radiculopathy and tarsal tunnel syndrome may be misleading, but using the presence of fibrillation potentials as a criterion may be useful. Differences in the pattern of abnormalities in males and females are also discussed.

Rationality in medicine is frequently construed as hypothetico-deductive. This article argues that such a model gives a distorted view of the rational character of an enterprise that makes judgments about individual human well-being. Medicine as a science is a practical human science. Seen as such, its rational orientation is one that applies general knowledge to particular situations. It is argued that such an orientation is not deductive but interpretative. The Aristotelian concept of practical wisdom ('phronesis') is used as a model of the rational orientation of clinical judgment.

A serendipitous observation that many individuals with carpal tunnel syndrome have square wrists led to this study which correlates wrist dimensions with median sensory latencies. Results suggest that the squarer the wrist the longer the latencies.

Employees from a large midwestern automobile manufacturing plant completed a preemployment evaluation which included a personal and family history, physical examination, and wrist ratio determinations obtained by dividing the anteroposterior diameter by the mediolateral diameter of the wrist. Over a 3-year period, 80 of these employees who developed symptoms compatible with carpal tunnel syndrome within 4-12 months of employment were entered into the study and were evaluated with standard electrodiagnostic techniques. The symptoms included nocturnal hand pain, paresthesia and weak grasp. Thirty-nine of the 80 employees had wrist ratios equal to or greater than 0.70. Twenty-four percent of the employees with wrist ratios less than 0.70 had abnormal electrodiagnostic studies compared with 74% of employees with wrist ratios greater than or equal to 0.70. Regression analysis performed on the data revealed a significant positive correlation between distal median motor latency and wrist ratio (P = 0.001). The study suggests the practical value of wrist ratio determination in job placement.

Prospective studies establish cognitive status as an important determinant of post-stroke rehabilitation success. The Neurobehavioral Cognitive Status Examination (NCSE) briefly assesses cognition in the ability areas of language, constructions, memory, calculation and reasoning. The NCSE, as well as the commonly used Mini-Mental State Examination and Albert's Test, were administered to 38 stroke patients before inpatient rehabilitation to determine the extent to which they predict rehabilitation outcome. Rehabilitation outcome was measured as the difference between initial and discharge Barthel Index score. The NCSE was shown to be a more sensitive indicator of impairment than the Mini-Mental State Examination and Albert's Test, especially in subsections of orientation and memory (X2 = 8.690, df = 1, P less than 0.005; X2 = 13.348, df = 1, P less than 0.001, respectively). Stepwise multiple regression revealed that attention, calculations and judgement were in association the best predictors of improvement in the Barthel Index scores. Therefore, the NCSE provides both a rapid and sensitive measure of cognitive function and it appears to predict functional status change as a result of inpatient stroke rehabilitation.