Revisiting the Examination of Sharp/Dull Discrimination as Clinical Measure of Spinothalamic Tract Integrity

Objective: Revisiting the sharp/dull discrimination as clinical measure of spinothalamic tract function considering the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Three clinically relevant factors were evaluated as to their impact on reliability: (1) the localization of dermatomes in relation to the sensory level, (2) the examination tool, and (3) the threshold of correct answers for grading of a preserved sharp/dull discrimination.Design: Prospective monocentric psychometric study.Setting: Spinal Cord Injury Center, Heidelberg University Hospital, Germany.Participants: Convenient sample of 21 individuals with subacute spinal cord injury (age: 31–82 years) and 20 individuals without spinal cord injury (age: 24–63 years).Assessment: All participants underwent three assessments for sharp/dull discrimination, applying five commonly used examination tools in seven dermatomes, performed by three trained examiners under conditions in accordance with ISNCSCI.Main Outcome Measures: Assessment of interrater reliability by determining both the Fleiss kappa (κ) coefficient and the percentage agreement between raters. Data were dichotomized regarding the ISNCSCI threshold.Results: Interrater reliability in individuals with SCI was overall substantial (κ = 0.68; CI 0.679–0.681) and moderate (κ = 0.54; CI 0.539–0.543) in dermatomes below the sensory level. All applied tools led to at least moderate reliability below the sensory level (lowest κ = 0.44; CI 0.432–0.440), with the officially endorsed safety pin achieving the highest (substantial) reliability (κ = 0.64; CI 0.638–0.646). Percentage agreement differed between non-SCI (97.3%) and formally intact above level dermatomes in SCI (89.2%).Conclusions: Sharp/dull discrimination as a common clinical examination technique for spinothalamic tract function is a reliable assessment. Independent from the used examination tools, reliability was substantial, with the medium-sized safety pin delivering the most favorable results. Notwithstanding this, all other tools could be considered if a safety pin is not available. Regarding interrater reliability and guessing probability, a threshold of 80% correct responses for preserved sharp/dull discrimination appears to be most suitable, which is in line with current clinical approaches and ISNCSCI. The causal attribution of the identified differences in sharp/dull discrimination between clinically intact dermatomes of individuals with SCI and unaffected dermatomes of individuals without SCI requires future work.Clinical Trial Registration Number (German Clinical Trials Register): DRKS00015334 (https://www.drks.de).

On Pins and Needles

This chapter examines the figure of the self-made man as expressed through two 2013 costume exhibits—the Rhode Island School of Design Museum’s exhibit on the dandy and the Metropolitan Museum of Art’s exhibit on punk. These exhibits forge a line of continuity between the punk and dandy that hinges on likening the safety pin to the straight pin. This chapter analyzes the differing epistemologies produced by each object in the context of men’s fashion. While the safety pin beckons amateur users and implies danger (while actually preventing it), the straight pin conceals the talent and work of others (the tailor). These objects therefore reveal different relationships to agency and temporality. The two exhibits produce a normative idea of masculinity as premised on spectacularity as performed through self-making and subversion while shifting the conversation away from the racialized contexts in which these practices of tailoring emerged. Material history allows us to nuance spectacularity and its politics.

Automatic Grenade Launcher

The remotely operated vehicle (ROV) grenade launcher is a weapon system, which can launch grenade remotely by a human operator, remotely operated vehicle has a launching range of up to 40 meters. It is a launcher designed to be capable of destroying enemies(snipers) hiding in buildings. It has a firing range for up to 40 meters. It launches grenades remotely by a launcher mounted on the vehicle. The grenade will also be loaded into the launcher automatically by using motors so that there is greater precision in handling the grenades, which are yet to be launched. This system also has a mechanism to remove the safety pins of the grenade. The camera mounted on the remotely operated vehicle is to provide video surveillance at operator. The whole system is operated remotely by Wi-Fi to control various operations. The vehicle is connected to the launcher by a micro controller kit and the interfacing is done accordingly. The Army can rely on the automatic grenade launcher to fulfil the requirement. In particular, the REMOTELY OPERATED VEHICLE grenade launcher allows for the use of a launcher mounted on a remotely operated vehicle to be operated remotely and deploy grenades with a video assistance. Along with the launcher’s position, remotely accessible camera, and the motion of the remotely operated vehicle are interfaced to a microcontroller. The safety pin removal system to remove safety pin of the grenades is also integrated to the circuit. Usage of the belt tires will help to minimize noise and favours the disguise of the vehicle. The video assists a wider vision to the operator, which helps to set the position of the launcher. In cases of incursions by the terrorists and capturing hostages, this REMOTELY OPERATED VEHICLE will be an important asset, this system puts at an added advantage to secure parameters without a human life risk.

An unusual case of Ayurvedic tablet as foreign body cricopharynx

<p class="abstract">A cricopharyngeal foreign body is a common emergency to any otolaryngologist in their clinical practice. Coins, button batteries, pencil tips, screws, tooth brush, safety pin are usually found in children but are rarely seen in adults in the cricopharynx. We present an unusual case of ayurvedic tablet as a foreign body in a 40-year-old female who swallowed an Ayurvedic tablet. She complained of absolute dysphagia to both solids and liquids. Such tablets are usually radiolucent and are not visualised on routine radiographs. Unexpectedly, on the X-ray lateral view of the neck, cricopharynx area showed a circular radio opaque shadow radio opaque shadow. Foreign body was removed by hypopharyngoscopy and patient was discharged with no complaints. Ayurvedic tablet as radio opaque shadow is a rare presentation and only one similar case has been reported so far.</p>