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Haas JW, Bender FL, Ballou S, Kelley JM, Wilhelm M, Miller FG, Rief W, Kaptchuk TJ. Frequency of Adverse Events in the Placebo Arms of COVID-19 Vaccine Trials: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2143955. [PMID: 35040967 PMCID: PMC8767431 DOI: 10.1001/jamanetworkopen.2021.43955] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/22/2021] [Indexed: 11/21/2022] Open
Abstract
Importance Adverse events (AEs) after placebo treatment are common in randomized clinical drug trials. Systematic evidence regarding these nocebo responses in vaccine trials is important for COVID-19 vaccination worldwide especially because concern about AEs is reported to be a reason for vaccination hesitancy. Objective To compare the frequencies of AEs reported in the placebo groups of COVID-19 vaccine trials with those reported in the vaccine groups. Data Sources For this systematic review and meta-analysis, the Medline (PubMed) and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched systematically using medical subheading terms and free-text keywords for trials of COVID-19 vaccines published up to July 14, 2021. Study Selection Randomized clinical trials of COVID-19 vaccines that investigated adults aged 16 years or older were selected if they assessed solicited AEs within 7 days of injection, included an inert placebo arm, and provided AE reports for both the vaccine and placebo groups separately. Full texts were reviewed for eligibility by 2 independent reviewers. Data Extraction and Synthesis Data extraction and quality assessment were performed independently by 2 reviewers, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and using the Cochrane risk-of-bias tool. Meta-analyses were based on random-effects models. Main Outcomes and Measures The primary outcomes were the proportions of placebo recipients reporting overall, systemic, and local (injection-site) AEs as well as logarithmic odds ratios (ORs) to evaluate group differences. Outcomes were tested for significance using z tests with 95% CIs. Results Twelve articles with AE reports for 45 380 participants (22 578 placebo recipients and 22 802 vaccine recipients) were analyzed. After the first dose, 35.2% (95% CI, 26.7%-43.7%) of placebo recipients experienced systemic AEs, with headache (19.3%; 95% CI, 13.6%-25.1%) and fatigue (16.7%; 95% CI, 9.8%-23.6%) being most common. After the second dose, 31.8% (95% CI, 28.7%-35.0%) of placebo recipients reported systemic AEs. The ratio between placebo and vaccine arms showed that nocebo responses accounted for 76.0% of systemic AEs after the first COVID-19 vaccine dose and for 51.8% after the second dose. Significantly more vaccine recipients reported AEs, but the group difference for systemic AEs was small after the first dose (OR, -0.47; 95% CI, -0.54 to -0.40; P < .001; standardized mean difference, -0.26; 95% CI, -0.30 to -0.22) and large after the second dose (OR, -1.36; 95% CI, -1.86 to -0.86; P < .001; standardized mean difference, -0.75; 95% CI, -1.03 to -0.47). Conclusions and Relevance In this systematic review and meta-analysis, significantly more AEs were reported in vaccine groups compared with placebo groups, but the rates of reported AEs in the placebo arms were still substantial. Public vaccination programs should consider these high rates of AEs in placebo arms.
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Meade A, Hembd A, Cho MJ, Zhang AY. Surgical Treatment of Upper Extremity Gunshot Injures: An Updated Review. Ann Plast Surg 2021; 86:S312-S318. [PMID: 33346543 DOI: 10.1097/sap.0000000000002634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Firearm morbidity and mortality have been increasing in recent years, and with this, the demand for medical personnel firearm injury treatment knowledge. Extremities contribute to a majority of firearm injuries, with these injuries being particularly complex because of neurovascular proximity within a confined space. Knowledge of firearm mechanism of injury and treatment management options is important for any trauma hand surgeon. Many factors play vital roles in the treatment of complex upper extremity (UE) gunshot wounds (GSWs). The aim of our review and case illustrations is to provide hand surgeons with an up-to-date guide for initial emergent management, soft tissue, bony, and nerve repair and reconstruction. PATIENT AND METHODS A literature review was conducted in the current management of UE GSW injuries, and 2 specific patient case examples were included. High-energy versus low-energy GSWs were documented and compared, as well as containment injures. Management including soft tissue, bony, and nerve injuries was explored along with patient outcome. Based on these findings, guidelines for GSW management were purposed. CONCLUSION Gunshot wounds of the UE encompass a group of highly heterogeneous injuries. High-energy wounds are more extensive, and concomitant injuries to bone, vessel, nerve, muscle, and soft tissue are common. Early treatment with adequate debridement, skeletal fixation, and soft tissue coverage is indicated for complex injuries, and antibiotic treatment in the pre-, peri-, and postoperative period is indicated for operative injuries. Soft tissue coverage options include the entire reconstructive ladder, with pattern of injury and considerations of wound characteristics dictating reconstructive choice. There are arguments to using either external or internal bony fixation techniques for bone fracture management, with choice tailored to the patient. For management of nerve injuries, we advocate earlier nerve repair and a shorter duration of observation before secondary reconstruction in selective cases. If transected nerve endings cannot be brought together, nerve autografts of shorter length are recommended to bridge nerve ending gaps. A significant number of patients with GSW fail to make necessary follow-up appointments, which adds to challenges in treatment.
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Gil JA, Weiss APC. The Weekend Warrior: Common Hand and Wrist Injuries in Athletes. RHODE ISLAND MEDICAL JOURNAL (2013) 2020; 103:49-53. [PMID: 32872690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Weekend warriors are individuals who condense their weekly physical activity into extended intervals over one or two days.1 Excessive physical activity can result in a multitude of overuse and traumatic upper extremity injuries. The purpose of this review is to highlight the etiology and management of the more common hand and wrist injuries in athletes.
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Chrischilles EA, Riley D, Letuchy E, Koehler L, Neuner J, Jernigan C, Gryzlak B, Segal N, McDowell B, Smith B, Sugg SL, Armer JM, Lizarraga IM. Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat 2019; 175:675-689. [PMID: 30852760 PMCID: PMC6534523 DOI: 10.1007/s10549-019-05184-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL. METHODS Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener. RESULTS Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction. CONCLUSIONS A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.
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Kelley ME, Talton JW, Weaver AA, Usoro AO, Barnard ER, Miller AN. Associations between upper extremity injury patterns in side impact motor vehicle collisions with occupant and crash characteristics. ACCIDENT; ANALYSIS AND PREVENTION 2019; 122:1-7. [PMID: 30296723 DOI: 10.1016/j.aap.2018.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 09/12/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Side impact motor vehicle collisions (MVC) represent a significant burden of mortality and morbidity caused by automotive injury within the United States. The objective of this study was to evaluate the relationship between upper extremity (UE) injury patterns and contact sources in side impact MVC with occupant and crash variables. METHODS Crash Injury Research and Engineering Network data obtained from 1998 to 2012 were used to evaluate UE injuries in side impact crashes. First row drivers and passengers that were at least 16 years old with complete crash information were included. Side impact crashes were defined to have an area of deformation to the side of the vehicle and a principal direction of force between 60° and 120° or 240° and 300°. Injuries were stratified by type, anatomic location, and Abbreviated Injury Scale (AIS) severity. Occupant variables included age, sex, height, weight, body mass index, and Injury Severity Score. Vehicle and crash variables included in the analysis were change in vehicle velocity at the time of impact, maximum door intrusion, maximum B-pillar intrusion, seat track position, belt use, vehicle type, impact type, and injury source. Statistical analysis of the UE injury data included descriptive statistics, linear regression analyses with occupant variables, and logistic regression analyses with vehicle and crash variables. RESULTS There were 903 UE injuries among 408 case occupants. The most common injury type was soft tissue injury (72.5%). The majority of fractures were proximal to and including the humerus (70.3%) with the clavicle being the most common fracture location (N = 89). AIS 2+ UE injuries were associated with a significantly higher mean occupant Injury Severity Score than AIS 1 UE injuries (p = 0.01). Contact with the door was the leading cause of UE injury (34.2%). The odds (OR [95% confidence interval], p-value) of an AIS 2+ UE injury due to contact with the B-pillar (5.3 [3.1, 9.1], <0.0001), door (1.9 [1.3, 2.7], 0.0006), and steering wheel/assembly (2.7 [1.1, 6.3], 0.03) were significantly higher than all other injury sources combined. Scapula fractures were significantly associated with rearward seat track positions (1.46 [1.04, 2.05], 0.03). CONCLUSIONS This study provides insight into UE injury patterns in side impact MVC. The clavicle was the most common UE fracture location. Contact with the door resulted in the highest number of UE injuries and the B-pillar resulted in the most severe injuries. Additionally, exposure to greater B-pillar intrusion was associated with increased odds of scapula and clavicle fractures in side impacts.
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Bosch LM, van der Molen HF, Frings-Dresen MHW. Optimizing implementation of interventions in agriculture for occupational upper extremity musculoskeletal disorders: Results of an expert panel. Work 2018; 61:413-420. [PMID: 30373985 PMCID: PMC6311361 DOI: 10.3233/wor-182806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Upper extremity musculoskeletal disorders (UEMSD) is reported worldwide as the second-largest occupational musculoskeletal disorder in agriculture. OBJECTIVE The objective of the study is to identify facilitators and barriers for employers and workers for implementing interventions to reduce work-related risk factors associated with occupational UEMSD in the agricultural sector, according to health and safety consultants. METHODS An expert panel was used comprising nine health and safety consultants from the Dutch agricultural sector. RESULTS Facilitators and barriers for employers and workers were categorized in the following themes: knowledge, skills, attitude, culture, costs, loss of income, facilitation and employability. There were no differences in facilitators and barriers between UEMSD. CONCLUSIONS Facilitators and barriers for implementing preventive interventions in agriculture were on organizational level, like diversity in choice of preventive devices, and personal level such as willingness if there is no work disability.
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Sparkman BK, Batson S. Asymptomatic Venous Bullet Emboli: Rationale for Nonoperative Management. Am Surg 2017; 83:e329-e331. [PMID: 28822378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Blue CT, Pospiech EA, Lewis JM, Nodit L. Soft Tissue Malignancy Due to Long-Standing Foreign Bodies after Shotgun Blast. Am Surg 2017; 83:e261-e263. [PMID: 28738932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Kaufman R, Fraade-Blanar L, Lipira A, Friedrich J, Bulger E. Severe soft tissue injuries of the upper extremity in motor vehicle crashes involving partial ejection: the protective role of side curtain airbags. ACCIDENT; ANALYSIS AND PREVENTION 2017; 102:144-152. [PMID: 28363171 DOI: 10.1016/j.aap.2017.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/19/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Partial ejection (PE) of the upper extremity (UE) can occur in a motor vehicle crash (MVC) resulting in complex and severe soft tissue injuries (SSTI). This study evaluated the relationship between partial ejection and UE injuries, notably SSTIs, in MVCs focusing on crash types and characteristics, and further examined the role of side curtain airbags (SCABs) in the prevention of partial ejection and reducing SSTI of the UE. METHODS Weighted data was analyzed from the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) from 1993 to 2012. Logistic regression models were used to assess the relationship of PE with SSTI of the UE and the effect of SCABs in both nearside impacts and rollover collisions. Crash Injury Research and Engineering Network (CIREN) case studies illustrated PE involving SSTI of the UE, and long term treatment. RESULTS Rollover and nearside impact collisions had the highest percentages of partial ejection, with over half occurring in rollover collisions. Annually over 800 SSTIs of the UE occurred in all MVCs. For nearside lateral force impacts, a multivariable analysis adjusting for belt use and delta V showed a 15 times (OR 15.35, 95% CI 4.30, 54.79) greater odds of PE for occupants without SCABs compared to those with a SCAB deployment. No occupants (0 of 51,000) sustained a SSTI of the UE when a SCAB deployed in nearside impacts, compared to 0.01% (114 of 430,000) when SCABs were unavailable or did not deploy. In rollover collisions, a multivariable analysis adjusted for number of quarter turns and belt use showed 3 times the odds (OR 3.02, 95% CI 1.22, 7.47) of PE for occupants without SCABs compared to those with a SCAB deployment. Just 0.17% (32 of 19,000) of the occupants sustained a SSTI of the UE in rollovers with a SCAB deployment, compared to 0.53% (2294 of 431,000) of the occupants when SCABs were unavailable or did not deploy. CIREN case studies illustrated the injury causation of SSTI of the UE due to partial ejection, and the long term treatment and medical costs associated with a SSTI to the UE. CONCLUSIONS The majority of severe soft tissue injuries (SSTI) of the upper extremity (UE) involved partial ejection out the nearside window of outboard seated occupants in nearside impacts and rollover collisions. Real world case studies showed that SSTIs of the upper extremity require extensive treatment, extended hospitalization and are costly. Occupants without a side curtain airbag (SCAB) deployment had an increase in the odds of partial ejection. SCAB deployments provided protection against partial ejection and prevented SSTIs of the UE, with none occurring in nearside impacts, and a small percentage and reduction occurring in rollover collisions compared to those where SCABs were unavailable or did not deploy.
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Braxton C, Bowles R. Hands-On Safety: Hand usage can affect cumulative trauma soft-tissue issues in the arms, neck, shoulders, and back. OCCUPATIONAL HEALTH & SAFETY (WACO, TEX.) 2017; 86:42-46. [PMID: 30211510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Suleiman FA, Almaaitah AA, Aqrabawi HE. Upper limb birth trauma in a Jordanian population: a prospective study at King Hussein Medical Centre, Amman, Jordan. J PAK MED ASSOC 2016; 66:1422-1426. [PMID: 27812060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the incidence of and the main risk factors related to upper limb injury at birth. METHODS This prospective study was conducted at the King Hussein Medical Centre, Amman, Jordan, from October 2014 to May 2015, and comprised newborns. The probable predisposing factors for upper limb birth injury and their relation to injury were analysed. SPSS 17 was used for data analysis. RESULTS Of the 5,030 live births, 5,003(99.46%) newborns were without and 27(0.54%) were with upper limb birth trauma (5.4 injuries per 1,000 live births). Moreover, 2,565(51%) were boys and 2,465(49%) were girls. Of the injured, 20(74%) patients had clavicle fracture, 3(11.1%) each had brachial plexus injuries and fractures to the humerus, and 1(3.7%) had olecranon fracture, translating into an incidence of 3.97, 0.6 and 0.2 per 1,000 live births, respectively. CONCLUSIONS Upper limb injury was not uncommon at birth. In most cases, such injuries were unpredictable and unpreventable.
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Ferran NA, Sher D. Bilateral Primary Repair of Simultaneous Bilateral Distal Biceps Rupture. BULLETIN OF THE HOSPITAL FOR JOINT DISEASE (2013) 2016; 74:234-236. [PMID: 27620548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A case of simultaneous bilateral distal biceps tendon rupture in a recreational gymnast is presented. Achieving bilateral acute primary repair can be challenging as any immobilization will lead to disability and difficulty with self-care and activities of daily living. We have reviewed the evidence of this rare condition and demonstrate that modern rehabilitation techniques, which allow early mobilization, can make simultaneous bilateral primary repair a viable option in such cases.
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Belfort MA, Shamshirsaz AA, Whitehead WE, Ball R, Silver R, Ruano R, Espinoza J, Mann DG, McCullough L, Chervenak F. Unusual pleuroamniotic shunt complication managed using a two-port in-CO2 fetoscopic technique: technical and ethical considerations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:123-124. [PMID: 26183219 DOI: 10.1002/uog.14947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/02/2015] [Accepted: 06/09/2015] [Indexed: 06/04/2023]
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Lowndes BR, Heald EA, Hallbeck MS. Ergonomics and comfort in lawn mower handle positioning: An evaluation of handle geometry. APPLIED ERGONOMICS 2015; 51:1-8. [PMID: 26154198 DOI: 10.1016/j.apergo.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 02/27/2015] [Accepted: 04/04/2015] [Indexed: 06/04/2023]
Abstract
Hand operation accompanied with any combination of large forces, awkward positions and repetition may lead to upper limb injury or illness and may be exacerbated by vibration. Commercial lawn mowers expose operators to these factors during actuation of hand controls and therefore may be a health concern. A nontraditional lawn mower control system may decrease upper limb illnesses and injuries through more neutral hand and body positioning. This study compared maximum grip strength in twelve different orientations (3 grip spans and 4 positions) and evaluated self-described comfortable handle positions. The results displayed force differences between nontraditional (X) and both vertical (V) and pistol (P) positions (p < 0.0001) and among the different grip spans (p < 0.0001). Based on these results, recommended designs should incorporate a tilt between 45 and 70°, handle rotations between 48 and 78°, and reduced force requirements or decreased grip spans to improve user health and comfort.
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Anderson AP, Newman DJ, Welsch RE. Statistical Evaluation of Causal Factors Associated with Astronaut Shoulder Injury in Space Suits. Aerosp Med Hum Perform 2015; 86:606-13. [PMID: 26102140 DOI: 10.3357/amhp.4220.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Shoulder injuries due to working inside the space suit are some of the most serious and debilitating injuries astronauts encounter. Space suit injuries occur primarily in the Neutral Buoyancy Laboratory (NBL) underwater training facility due to accumulated musculoskeletal stress. We quantitatively explored the underlying causal mechanisms of injury. METHODS Logistic regression was used to identify relevant space suit components, training environment variables, and anthropometric dimensions related to an increased propensity for space-suited injury. Two groups of subjects were analyzed: those whose reported shoulder incident is attributable to the NBL or working in the space suit, and those whose shoulder incidence began in active duty, meaning working in the suit could be a contributing factor. RESULTS For both groups, percent of training performed in the space suit planar hard upper torso (HUT) was the most important predictor variable for injury. Frequency of training and recovery between training were also significant metrics. The most relevant anthropometric dimensions were bideltoid breadth, expanded chest depth, and shoulder circumference. Finally, record of previous injury was found to be a relevant predictor for subsequent injury. The first statistical model correctly identifies 39% of injured subjects, while the second model correctly identifies 68% of injured subjects. DISCUSSION A review of the literature suggests this is the first work to quantitatively evaluate the hypothesized causal mechanisms of all space-suited shoulder injuries. Although limited in predictive capability, each of the identified variables can be monitored and modified operationally to reduce future impacts on an astronaut's health.
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Gritsenko V, Dailey E, Kyle N, Taylor M, Whittacre S, Swisher AK. Feasibility of Using Low-Cost Motion Capture for Automated Screening of Shoulder Motion Limitation after Breast Cancer Surgery. PLoS One 2015; 10:e0128809. [PMID: 26076031 PMCID: PMC4468119 DOI: 10.1371/journal.pone.0128809] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To determine if a low-cost, automated motion analysis system using Microsoft Kinect could accurately measure shoulder motion and detect motion impairments in women following breast cancer surgery. Design Descriptive study of motion measured via 2 methods. Setting Academic cancer center oncology clinic. Participants 20 women (mean age = 60 yrs) were assessed for active and passive shoulder motions during a routine post-operative clinic visit (mean = 18 days after surgery) following mastectomy (n = 4) or lumpectomy (n = 16) for breast cancer. Interventions Participants performed 3 repetitions of active and passive shoulder motions on the side of the breast surgery. Arm motion was recorded using motion capture by Kinect for Windows sensor and on video. Goniometric values were determined from video recordings, while motion capture data were transformed to joint angles using 2 methods (body angle and projection angle). Main Outcome Measure Correlation of motion capture with goniometry and detection of motion limitation. Results Active shoulder motion measured with low-cost motion capture agreed well with goniometry (r = 0.70–0.80), while passive shoulder motion measurements did not correlate well. Using motion capture, it was possible to reliably identify participants whose range of shoulder motion was reduced by 40% or more. Conclusions Low-cost, automated motion analysis may be acceptable to screen for moderate to severe motion impairments in active shoulder motion. Automatic detection of motion limitation may allow quick screening to be performed in an oncologist's office and trigger timely referrals for rehabilitation.
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Stringer RW, Mancini M. Blast-Induced Compartment Syndrome. J Emerg Med 2015; 49:e91-2. [PMID: 25910831 DOI: 10.1016/j.jemermed.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/02/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
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Riehl JT, Connolly K, Haidukewych G, Koval K. Fractures Due to Gunshot Wounds: Do Retained Bullet Fragments Affect Union? THE IOWA ORTHOPAEDIC JOURNAL 2015; 35:55-61. [PMID: 26361445 PMCID: PMC4492146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Many types of projectiles, including modern hollow point bullets, fragment into smaller pieces upon impact, particularly when striking bone. This study was performed to examine the effect on time to union with retained bullet material near a fracture site in cases of gunshot injury. METHODS All gunshot injuries operatively treated with internal fixation at a Level 1 Trauma Center between March 2008 and August 2011 were retrospectively reviewed. Retained bullet load near the fracture site was calculated based on percentage of material retained compared to the cortical diameter of the involved bone. Analyses were performed to assess the effect of the lead-cortical ratio and amount of comminution on time to fracture union. RESULTS Thirty-two patients (34 fractures) met the inclusion criteria, with an equal number of comminuted (17) and non-comminuted fractures (17). Seventeen of 34 fractures (50%) united within 4 months, 16/34 (47%) developed a delayed union, and 1/34 (3%) developed a nonunion requiring revision surgery. Sixteen of 17 fractures (94%) that united by 4 months had a cumulative amount of bullet fragmentation retained near the fracture site of less than 20% of the cortical diameter. Nine out of 10 fractures (90%) with retained fragments near the fracture site was equal to or exceeding 20% of the cortical diameter had delayed or nonunion. Fracture comminution had no effect on time to union. CONCLUSIONS The quantity of retained bullet material near the fracture site was more predictive of the rate of fracture union than was comminution. Fractures with bullet fragmentation equal to or exceeding 20% of the cortical width demonstrated a significantly higher rate of delayed union/nonunion compared to those fractures with less retained bullet material, which may indicate a local cytotoxic effect from lead on bone healing. These findings may influence decisions on timing of secondary surgeries. LEVEL OF EVIDENCE Level III.
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MESH Headings
- Arm Injuries/etiology
- Arm Injuries/surgery
- Cohort Studies
- Female
- Foreign Bodies
- Forensic Ballistics
- Fracture Fixation, Internal/adverse effects
- Fracture Fixation, Internal/methods
- Fracture Healing/physiology
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/etiology
- Fractures, Bone/surgery
- Fractures, Ununited/diagnostic imaging
- Fractures, Ununited/epidemiology
- Humans
- Lead/adverse effects
- Leg Injuries/etiology
- Leg Injuries/surgery
- Male
- Radiography
- Retrospective Studies
- Risk Assessment
- Trauma Centers
- Wounds, Gunshot/complications
- Wounds, Gunshot/diagnostic imaging
- Wounds, Gunshot/surgery
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Rhee HY, Cho JH, Seok JM, Cho TS, Jeon WJ, Lee JG, Kim SK. Prevalence of Musculoskeletal Disorders Among Korean Police Personnel. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2015; 70:177-188. [PMID: 24965328 DOI: 10.1080/19338244.2013.807762] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study was conducted to investigate efficient, systematic management of the Korean police and to examine the status and prevention of musculoskeletal disorders in Korean police officers. For police officers in special working environments, the importance of basic data is emphasized for human resources (HR) management and the prevention of industrial hazards from an industrial health care perspective. This study was conducted on police officers who visited the national police hospital and who underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) for the diagnosis of musculoskeletal disorders. The results revealed that examinations for the lower extremities and spine were most frequently conducted using x-ray, CT, and MRI. In particular, knee and lumbar examinations were most frequently conducted among all lower extremity and spine examinations, respectively.
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Keles MK, Aykan A, Yapici AK. Can an innocent toy become dangerous? The hydrogen gas balloon burn. Burns 2014; 41:415. [PMID: 25468479 DOI: 10.1016/j.burns.2014.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 11/16/2022]
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Eijckelhof BHW, Huysmans MA, Blatter BM, Leider PC, Johnson PW, van Dieën JH, Dennerlein JT, van der Beek AJ. Office workers' computer use patterns are associated with workplace stressors. APPLIED ERGONOMICS 2014; 45:1660-1667. [PMID: 25005311 DOI: 10.1016/j.apergo.2014.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 04/09/2014] [Accepted: 05/26/2014] [Indexed: 06/03/2023]
Abstract
This field study examined associations between workplace stressors and office workers' computer use patterns. We collected keyboard and mouse activities of 93 office workers (68F, 25M) for approximately two work weeks. Linear regression analyses examined the associations between self-reported effort, reward, overcommitment, and perceived stress and software-recorded computer use duration, number of short and long computer breaks, and pace of input device usage. Daily duration of computer use was, on average, 30 min longer for workers with high compared to low levels of overcommitment and perceived stress. The number of short computer breaks (30 s-5 min long) was approximately 20% lower for those with high compared to low effort and for those with low compared to high reward. These outcomes support the hypothesis that office workers' computer use patterns vary across individuals with different levels of workplace stressors.
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Kara M, Yalcin S, Malas FU, Tiftik T, Ozcakar L. Ultrasound imaging for the upper limb nerves in CRPS: a patient with electrical injury. Pain Physician 2014; 17:E556-E557. [PMID: 25054408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Zimmermann MS, Abzug JM, Chang J, Stern PJ, Osterman AL. Iatrogenic nerve injuries in common upper extremity procedures. Instr Course Lect 2014; 63:105-111. [PMID: 24720298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Iatrogenic nerve injuries frequently occur during procedures around the hand and wrist, although they are not always recognized at the time of injury or in the immediate postoperative period. Because preventing injuries is of paramount importance, extensive knowledge of the anatomy of the at-risk nerves is critical. Best results occur after immediate repair because a substantial delay before secondary surgery diminishes the chances for recovery from motor or sensory nerve dysfunction and relief from pain. It is helpful to review iatrogenic nerve injuries associated with common hand surgical procedures.
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Chrapusta A, Pąchalska M. Evaluation of differences in health-related quality of life during the treatment of post-burn scars in pre-school and school children. ANNALS OF AGRICULTURAL AND ENVIRONMENTAL MEDICINE : AAEM 2014; 21:861-865. [PMID: 25528935 DOI: 10.5604/12321966.1129947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of the research was an assessment of the differences in the self-evaluation of health-related quality of life during the treatment of post-burn scars on the upper limbs of pre-school and school children. MATERIALS AND METHOD a group of 120 children were examined--66 boys and 54 girls, divided into a pre-school group of 60 children (average age 4.3±1.7) and a primary school group of 60 children (average age 10.4±1.2). The structured interview and an adopted Visual Analog Anxiety Scale and Visual Analog Unpleasant Events Tolerance Scale were used to evaluate the level of plaster tolerance, and anxiety caused by the removal of dressings during treatment. RESULTS In the first test, In both groups, a low tolerance was noted to the pressure plaster, with the pre-school aged children obtaining worse results (x=18.9±SD 10.16) than those of school age (x=33.65±SD 13,21), regardless of gender. Pre-school children were afraid (x=47.5±SD 24.26), while school-aged children were not afraid of having the plaster removed (x=20.5±SD 9.46). The differences between the groups were statistically significant. In the fourth and final test on pre-school aged children, the tolerance of plasters had improved (x=23.24±SD 15.43) obtaining a value somewhat lower than for school-aged children (32.4±SD 6.45), as well as a noted fall in the anxiety level (30.83±SD 23.38) with an average value insignificantly higher than that recorded for the children of school age (15.83±SD 6.19). CONCLUSIONS The tests confirmed the appearance of differences in the self-evaluation of health-related life quality in pre-school and school-aged children.
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Abstract
Upper extremity transplantation has been at the forefront of vascularized composite allotransplantation. There have been more hand and upper extremity transplants than any other kinds of vascularized composite allotransplantation. However, it is a new and evolving field. Reconstructive surgeons are relative newcomers to the field of transplantation, and the procurement of upper extremity allografts has many subtleties that will differ depending on the intended recipient. However, there are certain principles that can be adhered to that this review serves to elucidate.
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