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    Jim Duvall | Sep 15th, 2014 6:51am PDT #

    Great data. You should be applauded for collecting it and presenting it. This is a conversation we all should be having. The more we talk about this issue the less likely someone will be caught unaware. Care should be taken to never say that "if you do xxx" nothing bad will happen. It is clear from the data given that any and all of the solutions people have proposed in the past have produced nerve insult.

    However some of you other conclusions have some weaknesses. I remember an old boss telling me when I was a brand new just graduated scientist. We were doing an experiment and not getting the answers we expected, or that our customer was paying for. I was demoralized and he said, "Every result is right, the trick is knowing what you actually measured". It is something I have gone back to many times since.

    The data set presented were self reported incidents. Therefore it is very important to fold into any conclusions ways in which data may be skewed by that process. One way is that for at least 10 years I and others have been teaching people not to put wraps in the gap. Early on in this game people all used the gap to stabilize the tie. It makes the most structural sense to use that gap to help hold the tie in place. When wrist drops started happening we blamed it on the gap and taught against it. So fewer people tie in the gap now vs other places. That is the first way your data could be leading you to a misconclusion. Possibly taking this data and normalizing it against the frequency of each type of tie occurring in the community. Say for example 50% of ties place the top wrap mid deltoid, then we would calibrate the numbers for mid deltoid using that percentage. And say 10% of the ties used the gap. Now we would alter the ratio of those two to represent the possibility that in 1000 incidents of each how often would nerve insult happen. You may or may not get a different conclusion. But no matter what your conclusion would be more accurate.

    The second is on the reporting themselves. say I tie in the gap, my bottom has wrist drop, and several people coach me on how to do the tie "properly". My self reporting may be fudged just a bit to now remember me tying almost in the gap pr near the gap but not in it. No one enjoys being wrong. Or at least most people do not.

    My background is not in social or medical research, and definitely not in occupational injury research. So I may as well be wrong and have missed other ways the conclusions could be different.

    Once again I want to thank you for doing this work. It is something we all need to be thinking about and learning more about.

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