The Importance of Differentiating Parsonage-Turner Syndrome From Cervical Radiculopathy: A Case Report.

Parsonage-Turner syndrome (PTS) is a rare disease process in which one develops acute-onset shoulder pain, followed by progressive weakness of the upper arm and shoulder girdle musculature. PTS is difficult to diagnose as it mimics similar presenting pathologies, most commonly, cervical radiculopathy (CR). Clinical presentation and diagnostic tests are particularly important to identify this rare syndrome, as the treatment for similar conditions may be more invasive. We present an interesting case of a 32-year-old female with severe unilateral shoulder pain, followed by weakness of her upper extremity musculature. The etiology of her symptoms cannot be concluded for certain; however, the aim of this case report is to increase awareness of this rare but potentially debilitating syndrome while also educating providers on the importance of differentiating PTS from the more commonly diagnosed CR.

The Role of Interventional Pain Management in Proteus Syndrome: A Case Report.

Proteus syndrome (PS) is a rare overgrowth disease process with only a few hundred cases being reported in the literature. Abnormal formation of the vertebral bodies causing scoliosis and spinal stenosis are common features that lead to debilitating pain in these patients. We present a case of a 35-year-old male landscaper with a history of PS causing severe scoliosis and vertebral overgrowth who underwent recurrent sets of multilevel zygapophyseal joint injections for management of his axial back pain. This case illustrates the utility of interventional spinal procedures in patients with progressive pain from PS.

Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of mRNA COVID-19 Vaccines?

MYTH: Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). FACT: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine.However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.

A comprehensive study of class incremental learning algorithms for visual tasks.

The ability of artificial agents to increment their capabilities when confronted with new data is an open challenge in artificial intelligence. The main challenge faced in such cases is catastrophic forgetting, i.e., the tendency of neural networks to underfit past data when new ones are ingested. A first group of approaches tackles forgetting by increasing deep model capacity to accommodate new knowledge. A second type of approaches fix the deep model size and introduce a mechanism whose objective is to ensure a good compromise between stability and plasticity of the model. While the first type of algorithms were compared thoroughly, this is not the case for methods which exploit a fixed size model. Here, we focus on the latter, place them in a common conceptual and experimental framework and propose the following contributions: (1) define six desirable properties of incremental learning algorithms and analyze them according to these properties, (2) introduce a unified formalization of the class-incremental learning problem, (3) propose a common evaluation framework which is more thorough than existing ones in terms of number of datasets, size of datasets, size of bounded memory and number of incremental states, (4) investigate the usefulness of herding for past exemplars selection, (5) provide experimental evidence that it is possible to obtain competitive performance without the use of knowledge distillation to tackle catastrophic forgetting and (6) facilitate reproducibility by integrating all tested methods in a common open-source repository. The main experimental finding is that none of the existing algorithms achieves the best results in all evaluated settings. Important differences arise notably if a bounded memory of past classes is allowed or not.

Pain Outcomes with an Elliptical Regimen (POWER) Study: Identifying the Proper Dosage of Exercise for Therapeutic Effect in Persons with Chronic Back Pain.

BACKGROUND CONTEXT: Exercise therapy for low back pain has long been prescribed as one of the initial remedies for back pain. Traditional therapy is completed under a therapist's supervision and consists of lumbar stabilization, aerobic exercise and stretching exercises. Recent studies have explored treating back pain with aerobic exercise such as walking which can be done anywhere and without supervision which is lower cost and easily administered. PURPOSE: To assess a therapeutic dosage of aerobic exercise that is associated with pain reduction in persons experiencing low back pain. STUDY DESIGN: Case series. PARTICIPANT DESCRIPTION: Sixteen patients entered the study and twelve patients completed the study (mean ± SD: age 51 ± 11 years; weight 89.2 ± 16 kg). Subjects were included if they were ages 18-65, had chronic back pain lasting for more than 3 months and a score of greater than 30% on the Oswestry Low Back Disability Questionnaire. METHODS: Subjects underwent a six-week exercise program using the elliptical trainer three times each week. Exercise duration was steadily increased each week for the length of the study. The total cumulative amount of work that coincided with significant reductions in chronic low back pain was then identified. RESULTS: At 4 weeks, pain scores were significantly reduced from baseline (3.2 vs 4.7, p<0.0001). This significant pain reduction corresponded to an average of 30.8 Kcal/kg of body mass in cumulative work performed. Pain was significantly reduced by 21% and 32% on the Oswestry Questionnaire and the PROMIS 29 respectively. CONCLUSIONS: These pilot findings suggest that approximately 30.8 kcal/Kg of accumulated physiological work is a therapeutic "dosage" of exercise needed for significant reduction in chronic back pain. Clinicians can begin to use this benchmark for their oversight of rehabilitation programs to determine if an exercise program has been sufficiently intense and long enough in duration for managing their patients with chronic low back pain.

Synthesis, transport properties and electronic structure of p-type Cu1+xMn2-xInTe4 (x = 0, 0.2, 0.3).

The synthesis, electronic structure and temperature dependent transport properties of polycrystalline Cu1+xMn2-xInTe4 (x = 0, 0.2, 0.3) are reported for the first time. These quaternary chalcogenides were synthesized by direct reaction of the elements, followed by solid state annealing and hot press densification. The thermal conductivity is low for all specimens and intrinsic to the material system. Furthermore, the off-stoichiometry specimens illustrate the sensitivity of the transport properties to stoichiometry, with a greater than two-orders-of magnitude increase in carrier concentration with increased Cu content. First principles calculations of the electronic structure are also reported, and are in agreement with the experimental data. This fundamental investigation shows the potential towards further optimization of the electrical properties that, in addition to the intrinsically low thermal conductivity, provides a basis for further research into the viability of this material system for potential energy-related applications.

Neck Pain and Lower Back Pain.

Neck pain is the fourth leading cause of disability. Acute neck pain largely resolves within 2 months. History and physical examination play a key role in ruling out some of the more serious causes for neck pain. The evidence for pharmacologic interventions for acute and chronic musculoskeletal neck pain is limited. Lower back pain is the leading cause of disability and productivity loss. Consultation with a physical medicine and rehabilitation spine specialist within 48 hours for acute pain and within 10 days for all patients with lower back pain may significantly decrease rate of surgical interventions and increase patient satisfaction.

Scope and Nature of Pain- and Analgesia-Related Content of the United States Medical Licensing Examination (USMLE).

Background: "The ongoing opioid crisis lies at the intersection of two substantial public health challenges-reducing the burden of suffering from pain and containing the rising toll of the harms that can result from the use of opioid medications" [1]. Improved pain education for health care providers is an essential component of the multidimensional response to both still-unmet challenges [2,3]. Despite the importance of licensing examinations in assuring competency in health care providers, there has been no prior appraisal of pain and related content within the United States Medical Licensing Examination (USMLE). Methods: An expert panel developed a novel methodology for characterizing USMLE questions based on pain core competencies and topical and public health relevance. Results: Under secure conditions, raters used this methodology to score 1,506 questions, with 28.7% (432) identified as including the word "pain." Of these, 232 questions (15.4% of the 1,506 USMLE questions reviewed) were assessed as being fully or partially related to pain, rather than just mentioning pain but not testing knowledge of its mechanisms and their implications for treatment. The large majority of questions related to pain (88%) focused on assessment rather than safe and effective pain management, or the context of pain. Conclusions: This emphasis on assessment misses other important aspects of safe and effective pain management, including those specific to opioid safety. Our findings inform ways to improve the long-term education of our medical and other graduates, thereby improving the health care of the populations they serve.

Thermally driven anomalous Hall effect transitions in FeRh.

Materials exhibiting controllable magnetic phase transitions are currently in demand for many spintronics applications. Here we investigate from first principles the electronic structure and intrinsic anomalous Hall, spin Hall and anomalous Nernst response properties of the FeRh metallic alloy which undergoes a thermally driven antiferromagnetic-to-ferromagnetic phase transition. We show that the energy band structures and underlying Berry curvatures have important signatures in the various Hall effects. Specifically, the suppression of the anomalous Hall and Nernst effects in the AFM state and a sign change in the spin Hall conductivity across the transition are found. It is suggested that the FeRh can be used a spin current detector capable of differentiating the spin Hall effect from other anomalous transverse effects. The implications of this material and its thermally driven phases as a spin current detection scheme are also discussed.