Four hundred and eleven workers from 4 different companies participated in a worksite

Four hundred and eleven workers from 4 different companies participated in a worksite screening program designed, in part, to estimate the prevalence of carpal tunnel syndrome (CTS). Each worker completed a discomfort survey and underwent limited nerve conduction testing of the median and ulnar sensory nerves in both wrists. The discomfort survey included a hand diagram which allowed subjects to shade in area(s) affected by numbness, burning, tingling, or pain. The discomfort survey also asked each worker to indicate whether she or he had experienced neuropathic symptoms (i.e., numbness, burning, tingling, or pain) in the wrist, hand or fingers of each hand, without regard to localization (i.e., median versus ulnar versus radial distribution), and also nocturnal occurrence of symptoms. Analyses involved comparing hand diagram scores and non localized wrist/hand/finger symptoms with electrodiagnostic test results. All configurations of hand diagram scores of the dominant hands had a statistically significant association with electrophysiologically determined median nerve dysfunction, but so did non localized symptom reports. The sensitivity, specificity, and positive predicted values of hand diagrams were poorer than those reported previously. While some test performance characteristics of hand diagrams were better than those for non localized distal extremity symptoms consistent with CTS, some were worse. Overall, our data suggest that hand diagrams are no better than using a questionnaire to determine if workers have experienced symptoms consistent with CTS in their wrists, hands or fingers without regard to localization. The choice of screening tool would depend on the goal of screening, in particular, whether it is more desirable to have slightly higher sensitivity or positive predictive value.

Infratentorial subdural empyemas are rare. The authors report three cases encountered between 1979 and 1988, representing a 3% incidence among all subdural empyemas. The common source was an ear infection. Clinical presentation encompassed a systemic febrile illness, headaches, and a stiff neck. Only one patient had an inconspicuous focal neurological deficit that suggested a cerebral location. Initial diagnosis was acute meningitis in each case. A lumbar puncture was ordered in all three cases but was actually performed in two without developing tonsillar herniation. Cerebrospinal fluid analysis confirmed the diagnosis of meningitis in one but was normal in the other. Computerized tomography allowed a precise diagnosis and localization of the pathology. All three patients received aggressive antibiotic therapy plus suboccipital craniectomy and aspiration of pus; catheter drainage was performed in two. Cultures were positive in one case and negative in the others. Two patients were cured without sequelae; the third patient was moribund at surgery and died. Although it is known that subdural empyemas may localize in the posterior fossa, only one previous report was found. Infratentorial subdural empyema may sometimes be an unrecognized companion of acute meningitis and is cured with antibiotic therapy alone.

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Beaches worldwide have been subjected to human impacts by the trampling of vegetation, leading to exposure that increases their vulnerability to erosion. Rehabilitation efforts have included dune revegetation and control of human, access along with information signs for public education. Long term evaluation of the success of these is largely lacking, particularly in Australia where there has been significant Natural Resource Management funding in the last 20 years. This study used beach monitoring profiles, sediment analysis, historical photographs and community surveys to evaluate beach rehabilitation activities at Turners Beach, Northern Tasmania, where significant community effort has been invested. Results showed that the western and central sections of Turners Beach have experienced overall accretion since 2006, with development of a foredune and evidence of marine derived sediment deposition. The eastern section continued to show some erosion, with informal access tracks remaining despite fencing and signage. After 15 years of rehabilitation, historical photographs and community survey showed that human access control using boardwalks and vegetation replanting has been successful, justifying the community effort and federal government funding that was invested at the time, and ongoing community and local government maintenance since. Dune fencing was also found to have partly contributed to rehabilitation success, while placement of rocks along the shoreline appeared to have had mixed results, and information signs were found to be the least successful management practice. Topographic survey of beach profiles was confirmed by this study to be an effective method for evaluation of erosion, justifying the involvement of surveyors, with such long term monitoring being beyond the scope of most projects. Community survey was also confirmed to be a valuable tool in identifying long term changes, and community participation to be successful in increasing the integrity and resilience of beach and dunes areas.