Levodopa improves physical fatigue in Parkinson's disease: a double-blind, placebo-controlled, crossover study.

We quantitatively investigated the effect of carbidopa/levodopa (25/100) on physical fatigue during finger tapping and force generation in a double-blind, placebo-controlled crossover study. Parkinson's disease (PD) subjects were randomly assigned to carbidopa/levodopa or placebo for Visit 1 or 2 and participated in the following two studies: (1) Finger tapping. Twenty-five PD patients used their index fingers to strike two keys 20 cm apart on a musical instrument digital interface (MIDI) keyboard. The slopes of the regression line of dwell time and movement time were used to assess the rate of fatigue development. (2) Force generation. Twelve PD patients contracted the wrist extensors maximally to obtain a baseline maximum voluntary contraction (BMVC) force. Then they repetitively contracted the wrist extensors at 50% of the BMVC for 7 seconds and rested for 3 seconds. An interval maximum voluntary contraction (IMVC) was measured every three repetitions. Fatigue was defined as an IMVC of less than 60% of the BMVC. The slope of the regression line of IMVC was used to assess the rate of force decline. These two studies were repeated 1 hour after carbidopa/levodopa (25/100) or placebo. Subjects filled out the Multidimensional Fatigue Inventory (MFI) at the beginning of the first visit. Results showed that the slope of dwell time decreased with levodopa but not with placebo (P = 0.004). The rate of force decline also decreased with levodopa but not with placebo (P = 0.01). The subscores in the dimension of physical fatigue in the MFI did not correlate with the rate changes in dwell time or the rate changes in force decline. We concluded that (1) levodopa improves physical fatigue in finger tapping and force generation, (2) physical fatigue in Parkinson's disease is at least partially related to dopamine deficiency, and (3) the MFI measures different aspects of physical fatigue compared with those measured by finger tapping and force generation.     

Bursitis due to Mycobacterium goodii, a recently described, rapidly growing mycobacterium

We report a case of olecranon bursitis due to Mycobacterium goodii in a 60-year-old man. Prior to recognition of his infection, he received intrabursal steroids and underwent olecranon bursectomy. His infection was cured with antimicrobial therapy consisting of doxycycline and ciprofloxacin. This case illustrates that previously unrecognized members of the Mycobacterium smegmatis group of mycobacteria have pathogenic potential.     

Follicular lymphomatoid papulosis

A patient with follicular lymphomatoid papulosis is reported. Only two cases of this rare variant have been previously reported in the literature. Lesions typical of lymphomatoid papulosis in this case were centered around disrupted hair follicles. They corresponded to the type A "histiocytic" variant of lymphomatoid papulosis. The histologic features and theories regarding histogenesis of this unusual disorder are discussed.     

Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database

Hernia - Inguinal hernia repair is one of the most common surgical operations, yet the optimal treatment strategy remains undefined. Treatment of symptomatic inguinal hernias include both surgical...     

Job marketability survey for athletic trainers in selected midwestern States

This study was conducted to determine job availability for athletic trainers in school and/or clinic settings in western Kansas, western Nebraska, western Oklahoma, and eastern Colorado. A survey was sent to 109 physical therapy (PT) clinics and 194 public schools to determine the major factors associated with job marketability. Of the 194 questionnaires mailed to the public schools, 119 were returned for a 61% response rate. Of the 109 questionnaires mailed to PT clinics, 57 were returned for a 52% response rate. Very few school districts (13%) hired their own trainer due to financial restrictions; therefore, the National Athletic Trainers' Association (NATA) athletic trainer would increase his/her likelihood of being hired if he/she was also teacher-certified. Most of the clinics responding would hire an NATA-certified athletic trainer if that individual was also licensed as a physical therapist, whereby, the trainer without PT licensure could be used for outreach programs for the local high schools. Essential factors identified by both the public school and clinic personnel for increasing the marketability of athletic trainers were: 1) NATA certification, 2) acquisition of an additional certification such as a teaching endorsement or a PT degree, and 3) willingness to provide services jointly to the schools and/or clinic with either being the primary hiring agent.     

Science and policy implications of defining environmental justice

Although 'environmental justice' is an increasingly important issue for policy makers and researchers, it remains for many a vague and abstract notion that is hard to define in practical, real-world terms. Part of the problem is that environmental justice is a complex, multidimensional construct that cannot easily be defined. Our aim in this article is to identify fundamental dimensions of environmental justice and highlight the resulting questions that are an inherent part of putting principles into practice. We argue that to have a constructive and informed debate about this emotionally charged topic, it is necessary to have a clear and workable definition of environmental justice. We do not propose our own definition, but instead point out that there are many possible legitimate definitions depending on one's beliefs, opinions, and values. The central point is not that a particular definition is right or wrong, but rather than choosing a definition has distinct implications for the formulation, implementation, and evaluation of both policy and science. These critical choices should be made explicit so that public dialogue can focus on the substance of this important policy issue.