Neuralgic amyotrophy: An update in evaluation, diagnosis, and treatment approaches.

Neuralgic amyotrophy (NA) is an underrecognized peripheral nerve disorder distinguished by severe pain followed by weakness in the distribution of one or more nerves, most commonly in the upper extremity. While classically felt to carry a favorable prognosis, updates in research have demonstrated that patients frequently endure delay in diagnosis and continue to experience long term pain, paresis, and fatigue even years after the diagnosis is made. A transition in therapeutic approach is recommended and described by this review, which emphasizes the necessity to target compensatory abnormal motor control and fatigue by focusing on motor coordination, energy conservation strategies, and behavioral change, rather than strength training which may worsen the symptoms.

More May Not be Better: Enhanced Spacecraft Shielding May Exacerbate Cognitive Decrements by Increasing Pion Exposures during Deep Space Exploration.

The pervasiveness of deep space radiation remains a confounding factor for the transit of humans through our solar system. Spacecraft shielding both protects astronauts but also contributes to absorbed dose through galactic cosmic ray interactions that produce secondary particles. The resultant biological effects drop to a minimum for aluminum shielding around 20 g/cm2 but increase with additional shielding.

A standardized ultrasound approach in neuralgic amyotrophy.

Neuralgic amyotrophy (NA), also referred to as idiopathic brachial plexitis and Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe shoulder pain followed by progressive upper limb weakness and muscle atrophy. While NA is incompletely understood and often difficult to diagnose, early recognition may prevent unnecessary tests and interventions and, in some situations, allow for prompt treatment, which can potentially minimize adverse long-term sequalae. High-resolution ultrasound (HRUS) has become a valuable tool in the diagnosis and evaluation of NA.

Impact of a Hybrid-Virtual Teaching Model on the Physical Examination Skills of Fourth-Year Medical Students.

A required fourth-year advanced core neurology-physical medicine and rehabilitation clerkship was adapted to hybrid format (2-wk remote; 2-wk in-person) during the COVID-19 pandemic. With teaching of the neurological physical examination being shifted to the remote component, we sought to determine whether this negatively affected student performance on an Objective Structured Clinical Examination, particularly the physical examination component. Mean pandemic-era total Objective Structured Clinical Examination scores ( n = 79, 85.

Impact of Predefined Angles and a Revised APPLES Mnemonic on Accuracy and Performance Time for Simulated Ultrasound-Guided Injections.

Objectives: Our objective was to determine whether predefined angles would improve performance time and accuracy of ultrasound-guided procedures by novice operators and whether a revised APPLES (approach, position, perpendicular, lift, entry, sweep) mnemonic was a helpful guide for performing the procedure.

Methods: Participants attempted to hit targets in-plane and out-of-plane at different depths with a needle under ultrasound guidance with and without predefined angles. Participants were then asked if they thought that the mnemonic would be helpful when learning both methods for ultrasound-guided procedures.

A Required, Combined Neurology-Physical Medicine and Rehabilitation Clerkship Addresses Clinical and Health Systems Knowledge Gaps for Fourth-Year Medical Students.

This study evaluated the impact of a 4-wk mandatory neurology-physical medicine and rehabilitation advanced-core clerkship for fourth-year medical students. The combined clerkship encouraged an interdisciplinary and function-based approach to the management of common neurologic, musculoskeletal, and pain complaints. Seventy-three fourth-year medical students participated in the rotation over 1 yr.

Advances in space radiation physics and transport at NASA.

The space radiation environment is a complex mixture of particle types and energies originating from sources inside and outside of the galaxy. These environments may be modified by the heliospheric and geomagnetic conditions as well as planetary bodies and vehicle or habitat mass shielding. In low Earth orbit (LEO), the geomagnetic field deflects a portion of the galactic cosmic rays (GCR) and all but the most intense solar particle events (SPE).

Comparison of space radiation GCR models to AMS heavy ion data.

Galactic cosmic rays (GCR) are a constant source of radiation that constitutes one of the major hazards during deep space exploration missions for both astronauts and hardware. In this work, GCR models commonly used by the space radiation protection community are compared with recently published high-precision, high-resolution measurements of cosmic ray lithium, beryllium, boron, carbon, nitrogen, and oxygen fluxes along with their ratios (Li/B, Li/C, Li/O, Be/B, Be/C, Be/O, B/C, B/O, C/O, N/B, N/O) from the Alpha Magnetic Spectrometer (AMS). All of the models were developed and calibrated prior to the publication of this AMS data, therefore this is an opportunity to validate the models against an independent data set.

Ultrasound-guided treatment of peripheral entrapment mononeuropathies.

The advent of high-resolution neuromuscular ultrasound (US) has provided a useful tool for conservative treatment of peripheral entrapment mononeuropathies. US-guided interventions require careful coordination of transducer and needle movement along with a detailed understanding of sonoanatomy. Preprocedural planning and positioning can be helpful in performing these interventions.

A Simple, Realistic, Inexpensive Nerve Phantom.

Ultrasound-guided nerve blocks are common techniques in several medical specialties. Phantoms are commonly used when teaching these procedures. Commercial phantoms are expensive, and most previously published "homemade" nerve phantoms have a substantial amount of posterior shadowing, making it difficult to visualize the needle posterior to the simulated nerve.

Palmaris Longus Tendinopathy Diagnosed With Ultrasound: A Case Report.

This patient is a 52-year-old woman who was referred to the electrodiagnostic (EDX) laboratory for evaluation of pain and paresthesias of the left upper limb. The results of the EDX study were normal. However, ultrasound revealed tendinopathy of the palmaris longus tendon, manifested by increased hypoechogenicity, caliber, and tenderness in response to sonopalpation compared to the right side.

Accelerator-Based Tests of Shielding Effectiveness of Different Materials and Multilayers using High-Energy Light and Heavy Ions.

The roadmap for space exploration foresees longer journeys and further excursions outside low-Earth orbit as well as the establishment of permanent outposts on other celestial bodies, such as the Moon or Mars. The design of spacecrafts and habitats depends heavily on the mission scenario and must consider the radiation protection properties of the structural components as well as dedicated shielding. In fact, short- and long-term effects caused by exposure to cosmic radiation are now considered among the main health risks of space travel.

Comparison of space radiation GCR models to recent AMS data.

This paper is the third in a series of comparisons of American (NASA) and Russian (ROSCOSMOS) space radiation calculations. The present work focuses on calculation of fluxes of galactic cosmic rays (GCR), which are a constant source of radiation that constitutes one of the major hazards during deep space exploration missions for both astronauts/cosmonauts and hardware. In this work, commonly used GCR models are compared with recently published measurements of cosmic ray Hydrogen, Helium, and the Boron-to-Carbon ratio from the Alpha Magnetic Spectrometer (AMS).

Solar particle event storm shelter requirements for missions beyond low Earth orbit.

Protecting spacecraft crews from energetic space radiations that pose both chronic and acute health risks is a critical issue for future missions beyond low Earth orbit (LEO). Chronic health risks are possible from both galactic cosmic ray and solar energetic particle event (SPE) exposures. However, SPE exposures also can pose significant short term risks including, if dose levels are high enough, acute radiation syndrome effects that can be mission- or life-threatening.

Improving the Performance Time and Accuracy of Ultrasound-Guided Interventions: A Randomized Controlled Double-Blind Trial of the Line-of-Sight Approach and the "APPLES" Mnemonic.

Objectives: To determine whether the line-of-sight approach improved the performance time and accuracy of ultrasound (US)-guided needle placement targeting the subdeltoid bursa in a cadaver among novice operators compared to the side approach. A secondary objective was to determine whether participants thought the APPLES (angle, position, perpendicular, line up, entry, sweep) mnemonic was a helpful guide for performing the procedure.

Methods: Medical students and residents were randomized into either a line-of-sight or side approach group and then crossed over to the other group.

SHIELD and HZETRN Comparisons of Pion Production Cross Sections.

A program of comparing American (NASA) and Russian (ROSCOSMOS) space radiation transport codes has recently begun, and the first paper directly comparing the NASA and ROSCOSMOS space radiation transport codes, HZETRN and SHIELD respectively has recently appeared. The present work represents the second time that NASA and ROSCOSMOS calculations have been directly compared, and the focus here is on models of pion production cross sections used in the two transport codes mentioned above. It was found that these models are in overall moderate agreement with each other and with experimental data.

Comparing HZETRN, SHIELD, FLUKA and GEANT transport codes.

For the first time, the American (NASA) and Russian (ROSCOSMOS) space radiation transport codes, HZETRN and SHIELD respectively, are directly compared to each other. Calculations are presented for Galactic Cosmic Ray (GCR) minimum Hydrogen, Oxygen and Iron projectiles incident on a uniform Aluminum cylinder of varying thickness. Comparisons are made for the flux spectra of neutrons, light ions (Z≤ 2), heavy ions (Z> 2) and pions emitted from the back of the Aluminum cylinder.

Impact of a Revised Curriculum Focusing on Clinical Neurology and Musculoskeletal Care on a Required Fourth-Year Medical Student Physical Medicine and Rehabilitation Clerkship.

. A Required Fourth-Year Medical Student Physical Medicine and Rehabilitation (PM&R) Clerkship was found to increase students' knowledge of PM&R; however the students' overall rotation evaluations were consistently lower than the other 8 required clerkships at the medical school. .

Reference field specification and preliminary beam selection strategy for accelerator-based GCR simulation.

The galactic cosmic ray (GCR) simulator at the NASA Space Radiation Laboratory (NSRL) is intended to deliver the broad spectrum of particles and energies encountered in deep space to biological targets in a controlled laboratory setting. In this work, certain aspects of simulating the GCR environment in the laboratory are discussed. Reference field specification and beam selection strategies at NSRL are the main focus, but the analysis presented herein may be modified for other facilities and possible biological considerations.

Galactic cosmic ray simulation at the NASA Space Radiation Laboratory.

Most accelerator-based space radiation experiments have been performed with single ion beams at fixed energies. However, the space radiation environment consists of a wide variety of ion species with a continuous range of energies. Due to recent developments in beam switching technology implemented at the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL), it is now possible to rapidly switch ion species and energies, allowing for the possibility to more realistically simulate the actual radiation environment found in space.