Ultrasound-Guided Subgluteal Sciatic Nerve Perineural Injection: Report on Safety and Efficacy at a Single Institution.

OBJECTIVES: To determine the safety and efficacy of ultrasound (US)-guided subgluteal sciatic nerve injections. METHODS: A retrospective chart review of US-guided subgluteal sciatic nerve injections at our institution was performed. RESULTS: Of 221 US-guided subgluteal sciatic nerve injections, 100% achieved technical success, with no postprocedure complications. Sixty-eight percent of patients with follow-up reported symptom relief. Most patients with no relief had suboptimal preprocedure screening. CONCLUSIONS: With appropriate screening, our technique of US-guided subgluteal sciatic nerve injection is safe and effective.

Putting down the revolt: Enactivism as a philosophy of nature.

Enactivists frequently argue their account heralds a revolution in cognitive science: enactivism will unseat cognitivism as the dominant paradigm. We examine the lines of reasoning enactivists employ in stirring revolt, but show that none of these prove compelling reasons for cognitivism to be replaced by enactivism. First, we examine the hard sell of enactivism: enactivism reveals a critical explanatory gap at the heart of cognitivism. We show that enactivism does not meet the requirements to incite a paradigm shift in the Kuhnian sense-there is no internal crisis in cognitivism. Nor does it provide inherently better explanations of cognition as some have claimed. Second, we consider the soft sell of enactivism: enactivism provides a more attractive, parsimonious, or clear-eyed lens on cognition. This move proves to boil down to a misunderstanding of how theories are selected in science. Instead we lend support to a broader and more desirable way to conceive of enactivism, the recent proposal that enactivism is a philosophy of nature. We explain how a philosophy of nature does more than support a single research paradigm by integrating scientific questions into a cohesive picture.

The misinterpretation rates of radiology residents on emergent neuroradiology magnetic resonance (MR) angiogram studies: correlation with level of residency training.

The purpose of this study was to determine the discrepancy rates of radiology residents interpreting emergent neck and Circle of Willis magnetic resonance angiography (MRA) studies and to detect any adverse clinical outcomes. Three hundred seventeen MRA studies given preliminary reading by radiology residents were retrospectively reviewed over a 2-year period. Discrepancies were classified as either false negatives (failure to diagnose abnormalities) or false positives (misinterpreting normal scans as abnormal). The overall discrepancy rate was 12.1% for Circle of Willis MRA and 7.9% for neck MRA. Fourth-year residents had the lowest discrepancy rates (7.7%), but this was not statistically significant. The most common misses were stenosis greater than 70% (n = 9) and aneurysm (n = 12). No adverse clinical outcome was detected mainly due to rapid turnaround time for final reporting.

Discrepancy rates of on-call radiology residents' interpretations of CT angiography studies of the neck and circle of Willis.

OBJECTIVE: The purpose of our study was to determine the discrepancy rates of radiology residents' interpretations of emergent CT angiography (CTA) studies of the neck and circle of Willis and to assess any adverse clinical outcomes. MATERIALS AND METHODS: Five hundred thirty-eight CTA studies (287 circle of Willis and 251 neck) ordered emergently after hours and given preliminary readings by radiology residents from January 1, 2006, through December 31, 2007, were retrospectively reviewed. Discrepancies between the interpretations of radiology residents and the final reports of neuroradiology attending physicians were classified as either false-negatives (failure to recognize abnormalities) or false-positives (misinterpreting normal scans as abnormal). Discrepancies that could affect patient care or clinical care were considered major. RESULTS: Overall, the discrepancy rate was 13.6% for circle of Willis CTA and 13.5% for neck CTA. The misinterpretation rate of first-year residents was 19.5%, which was statistically significant compared with more senior-level residents (p = 0.05). There were 57 false-negative interpretations. The most common misses were stenosis greater than 50% (n = 16) and aneurysm (n = 15), and the most common false-positive was overcalling a potential intracranial aneurysm (n = 7). No adverse clinical outcomes were detected. CONCLUSION: The discrepancy rate between interpretations by on-call radiology residents and attending physicians of neuroradiology CTA studies was higher than expected at 13.6%, with a statistically significant greater miss rate among the most junior residents, which may be mitigated by recent changes with respect to the radiology residents' overnight call. No adverse clinical outcome was detected.

Widespread natural variation in murine natural killer T-cell number and function.

Natural killer T (NKT) cells comprise a novel T-lymphocyte subset that can influence a wide variety of immune responses through their ability to secrete large amounts of a variety of cytokines. Although variation in NKT-cell number and function has been extensively studied in autoimmune disease-prone mice, in which it has been linked to disease susceptibility, relatively little is known of the natural variation of NKT-cell number and function among normal inbred mouse strains. Here, we demonstrate strain-dependent variation in the susceptibility of C57BL/6J and BALB/cJ mice to NKT-mediated airway hyperreactivity, which correlated with significant increases in serum interleukin-4 (IL-4) and IL-13 elicited by the synthetic glycosphingolipid alpha-galactosylceramide. Examination of NKT-cell function revealed a significantly greater frequency of cytokine-producing NKT cells in C57BL/6J versus BALB/cJ mice as well as significant differences in the kinetics of NKT-cell cytokine production. Extension of this analysis to a panel of inbred mouse strains indicated that variability in NKT-cell cytokine production was widespread. Similarly, an examination of NKT-cell frequency revealed a significantly greater number of liver NKT cells in the C57BL/6J mice versus BALB/cJ mouse livers. Again, examination of a panel of inbred mouse strains revealed that liver NKT-cell numbers were quite variable, spanning over a 100-fold range. Taken together, these results demonstrate the presence of widespread natural variation in NKT-cell number and function among common inbred mouse strains, which may have implications for the examination of the influence of NKT cells in immune responses and disease pathogenesis among different genetic backgrounds.

Public awareness of mercury in fish: analysis of public awareness and assessment of fish consumption in vermont.

Exposure to mercury from environmental sources, such as fish consumption, poses potential health risks to the public. The state of Vermont has developed educational brochures and posters displaying safe fish consumption guidelines in order to educate the public regarding mercury exposure through fish. In this study, a group of medical students from the University of Vermont College of Medicine, in partnership with the Vermont Department of Health, conducted a study in Chittenden County, Vermont in order to assess both fish consumption practices and overall awareness of such safe eating guidelines and mercury advisories. A total of 166 Vermont residents were surveyed during a six week period. The results of this survey suggest that in Chittenden county of Vermont, these educational efforts are markedly successful, with 48% of respondents being specifically aware of the safe eating guidelines. Further, these results suggest that 61% of those respondents that reported low monthly canned tuna consumption had a decreased their consumption in response to the safe eating guidelines. last, a series of specific, yet widely applicable recommendations are presented for future public educational efforts regarding mercury exposure through fish consumption.

The Book of Job: a 2,500-year-old current guide to the practice of oncology: the nexus of medicine and spirituality.

GOALS: To establish the role of ancient literature and religious tradition to the modern practice of oncology; foster awareness of practicing in a historical context resulting from different traditions; and propose a spiritual context for the practice of oncology and explore methods to highlight this perspective in cancer education. METHOD: Contextual and content analysis of a religious text shared by the most common religious traditions of the West (Christianity, Judaism, and Islam). RESULTS: The origin of suffering eludes all logical explanations. All religious traditions affirm that the sufferer should be heard, cared for, and kept part of the human consortium, and under no circumstances blamed for the disease. In terms of oncology practice this means that the treatment should be negotiated with the patient according to his or her need; that physicians' obligations for care continues after the treatment fails, and that patients' lifestyles or poor compliance should not be blamed for poor outcomes. CONCLUSIONS: The Book of Job supports a spiritual perspective in oncology practice, indicating that patient care is a holistic endeavor. This perspective is the key to dealing with common interactive problems, such as adversarial relations between patient and provider in face of death and suffering, and more important, may promote care beyond treatment of the disease.