Lumbar spine forces during manoeuvring of ceiling-based and floor-based patient transfer devices

Patient handling continues to represent a high risk task for low back pain (LBP) among health caregivers. Previous studies indicated that manual transfers of patients impose unacceptable loads on the spine even when two caregivers perform the transfer. Patient lift devices are considered a potential intervention; however, few biomechanical analyses have investigated the spine loads and LBP risk associated with these transfer devices. This study analysed the 3-D spine forces imposed upon the lumbar spine when 10 subjects manipulated ceiling-based and floor-based patient lifts through various patient handling conditions and manoeuvres. The results indicated that ceiling-mounted patient lift systems imposed spine forces upon the lumbar spine that would be considered safe, whereas floor-based patient handling systems had the potential to increase anterior/posterior shear forces to unacceptable levels during patient handling manoeuvres. Given these findings, ceiling-based lifts are preferable to floor-based patient transfer systems.

Effect on MRSA transmission of rapid PCR testing of patients admitted to critical care

We report a significant reduction in the rate of meticillin-resistant Staphylococcus aureus (MRSA) transmission on a critical care unit when admission screening by culture was replaced with a same-day polymerase chain reaction (PCR) test. This was an observational cohort study, set in a 19-bed mixed medical and surgical adult critical care unit in southwest England. We studied 1305 patients admitted between April 2005 and February 2006. Standard MRSA culture methods were used to screen 612 patients between April 2005 and August 2005, and the IDI MRSA PCR test was used to screen 693 patients between September 2005 and February 2006. Standard infection control precautions were instituted when positive results were obtained by either method. Outcome measures included carriage rate, turnaround time for results and rate of subsequent MRSA transmission on the unit. The overall carriage rate on admission to the unit was 7.0%. Culture results were available in three working days, PCR results within one working day. The mean incidence of MRSA transmission was 13.89/1000 patient days during the culture phase and 4.9/1000 patient days during the PCR phase (relative risk reduction 0.65, 95% CI 0.28-1.07). PCR screening for MRSA on admission to critical care units is feasible in routine clinical practice, provides quicker results than culture-based screening and is associated with a significant reduction in subsequent MRSA transmission.

A demographic database for monitoring community life support skills

Training in community life support has been shown to lessen the mortality from sudden myocardial events 1. Such community training is badly quantified and its efficacy difficult to prove. In a diversity of communities in the West of Scotland emergency life support (ELS) training schemes have been set up in localities ranging from isolated islands to urban centres with considerable social disadvantage. An Access database 2 was created that has captured demographic data about those trained. This simple technique, with data-capture from a wide range of lay trainers, is demonstrating at its crudest exactly how many have been trained. It can show population rates of training and compare these with the international target of 20% of the population. It highlights the age bands of those trained and whether the socially disadvantaged are having equitable training. UK Post-code (Zip-code) has in parallel with other Scottish work 3 been used as a proxy for social circumstances. The greatest value of the database is that it is ready to be married up with national data from the Scottish Ambulance Service and allied studies 4 to show over time how effective the training is in altering mortality. The effort in creating and maintaining such an epidemiological database requires faith. It is the "posterity planting" of modern public health medicine.

Effect of COX-2 inhibitor NS-398 on expression of PGE2 receptor subtypes in M-1 mouse CCD cells

Our present study has investigated the effect of cyclooxygenase-2 (COX-2) inhibition on prostaglandin E2 (PGE2) receptor expression in M-1 cortical collecting duct cells and measured their response to PGE2. Using a semiquantitative titration analysis method, we show that following the addition of the COX-2-specific inhibitor NS-398, E-prostanoid receptor subtype (EP3 and EP4) mRNA expression was found to increase threefold each vs. the vehicle-treated control. We also observed that EP1 but not EP2 is expressed in M-1 cells and EP2 levels are not induced by NS-398. To determine the status of the PGE2 response on exposure to NS-398, we measured cAMP levels in cells after stimulation with varying concentrations of PGE2, then pretreated the cells with 10 microM NS-398 before PGE2 exposure and found a significant rise in the stimulatory effect of PGE2 on cAMP production. Finally, Western blot analysis of the levels of the EP4 receptor protein in control vs. NS-398-treated cells revealed an induction in protein levels in these cells, correlating with the induction in EP4 mRNA. We conclude that NS-398 upregulates the expression of EP3 and EP4 mRNA in M-1 cells. Also, EP4 protein levels are increased, resulting in an increased stimulation of cAMP production by PGE2.

Clinical and psychological correlates of lumbar motion abnormalities in low back disorders

BACKGROUND CONTEXT

Low back pain (LBP) and low back disorders (LBDs) identify a complex constellation of conditions that frustrate both diagnosis and therapy. Dynamic quantitative assessment and questionnaire instruments directed toward psychosocial and situational variables provide potentially powerful tools for determining functional pathology and potentially outcome.

PURPOSE

Our goal was to independently assess clinical correlates of a trunk motion measurement device, the lumbar motion monitor (LMM). The reliability of the LMM as a clinical test was assessed by comparison with an independent medical examination and biobehavioral questionnaires.

STUDY DESIGN/SETTING

There were three study components. A multispecialty physician panel that administered a structured physical examination contributed to a clinical correlation case series study. Standardized outcomes and risk identification questionnaires were administered to the case population. Finally, the LMM was administered in a customary fashion to the same population.

PATIENT SAMPLE

Nineteen subjects were recruited on the basis of criteria that included symptoms of chronic recurrent low back pain. This was an employed and active, although impaired, population. Eighteen of the subjects were currently employed with limited lost work time, but chronic and recurrent pain was a common feature.

OUTCOME MEASURES

Questionnaire outcome measures were both characterologic and situation based. In addition to providing diagnoses, the physician panel was also asked to offer certain qualitative assessments, such as rehabilitative potential and functional level pertinent to activities of daily living. The impact of LMM measures on physician decision making was also assessed. Trunk angular measurements were used to assess function of patients with chronic low back disorders.

METHODS

Kinematic performance on the LMM was expressed as three probability scores. These were the likelihood of abnormality, the "sincerity of effort" (exacerbation or aggravation of impairment), and the likelihood of structural anatomic disease. These variables were examined against established self-report measures of pain and disability.

RESULTS

The LMM and physician panels were in agreement on the presence or absence of abnormality. LMM findings tended to be more consistent with clinical history than the clinical examination. The LMM results were also generally consistent with the self-reported measures of pain and disability: a high likelihood of structural disease was associated with depression, somatization, poor health perception and diminished vitality.

CONCLUSIONS

The LMM appears to be a useful assessment tool for gauging the presence of LBP and LBD. It was accurate in detecting abnormality when abnormality was determined by clinical history and physician diagnosis. The LMM's differentiation of mechanical low back disease (nonanatomically specific disorders) from structurally specific low back disease was not consistent with a parallel clinical differentiation. Larger trials in a prospective format and studies on a chronically disabled population seem warranted. In an impaired but less disabled population, elevated pain and somatization did not appear to weaken the effort during testing.

Cardiac performance in endurance-trained and moderately active young women

PURPOSE

To compare the cardiac performance of endurance-trained (ET) and moderately active (MA) young women before exercise and throughout incremental work rates to maximum with particular interest in whether their stroke volume (SV) levels off at a submaximal work rate or increases to maximum.

METHODS

Blood volume (BV), and exercise cardiac performance were examined in seven ET (VO2max = 64.3 +/- 2.0 mL.kg(-1).min(-1)) and seven MA (VO2max = 42.1 +/- 1.0 mL.kg(-1).min(-1)) women, aged 18-30 yr. Cardiac time intervals were measured at matched heart rates (HR).

RESULTS

ET had a significantly larger BV than MA in both mL (ET = 5053 +/- 139, MA = 4327 +/- 202) and mL.kg(-1) (ET = 83.1 +/- 1.4, MA = 72.9 +/- 2.7). The SV of ET was significantly larger than the SV of MA throughout exercise, and the SV of ET increased progressively throughout incremental work rates to maximum. Although the SV of MA initially leveled off at a submaximal work rate, it underwent a secondary increase at very heavy work rates. Both diastolic filling rate (DFR) and left ventricular emptying rate (LVER) were significantly faster in ET compared with MA at HR of 150 bpm, 170 bpm and HRmax, and in both ET and MA, DFR was significantly faster than LVER at 170 bpm and HRmax.

CONCLUSIONS

In young women, ET have a larger SV than MA due to an enhanced DFR and LVER, with the primary advantage being DFR (possibly due to their larger BV). In addition, the SV of ET increases progressively throughout incremental work rates to maximum with no plateau, whereas the SV of MA levels off through moderate to heavy work rates then undergoes a secondary increase at very heavy work rates.

Anti-Sm B cell differentiation in Ig transgenic MRL/Mp-lpr/lpr mice: altered differentiation and an accelerated response

To determine the regulation of B cells specific for the ribonucleoprotein Sm, a target of the immune system in human and mouse lupus, we have generated mice carrying an anti-Sm H chain transgene (2-12H). Anti-Sm B cells in nonautoimmune 2-12H-transgenic (Tg) mice are functional, but, in the absence of immunization, circulating anti-Sm Ab levels are not different from those of non-Tg mice. In this report, we compare the regulation of anti-Sm B cells in nonautoimmune and autoimmune MRL/Mp-lpr/lpr (MRL/lpr) and bcl-2-22-Tg mice. Activation markers are elevated on splenic and peritoneal anti-Sm B cells of both nonautoimmune and autoimmune genetic backgrounds indicating Ag encounter. Although tolerance to Sm is maintained in 2-12H/bcl-2-22-Tg mice, it is lost in 2-12H-Tg MRL/lpr mice, as the transgene accelerates and increases the prevalence of the anti-Sm response. The 2-12H-Tg MRL/lpr mice have transitional anti-Sm B cells in the spleen similar to nonautoimmune mice. However, in contrast to nonautoimmune mice, there are few if any peritoneal anti-Sm B-1 cells. These data suggest that a defect in B-1 differentiation may be a factor in the loss of tolerance to Sm and provide insight into the low prevalence of the anti-Sm response in lupus.

Delineating Canadian and Greenland polar bear (Ursus maritimus) populations by cluster analysis of movements

Within their circumpolar range, polar bears (Ursus maritimus) are not subject to absolute barriers. However, physiographic features do cause discontinuities in their movements. These discontinuities in distribution can be used to delineate population units. Based on satellite telemetry of the movements of female polar bears carried out in 1989–1998, we used cluster analysis to identify 6 regions within the Canadian and western Greenland Arctic in which movements appear to be restricted enough to identify distinct populations. These regions generally correspond to management units that have been previously identified as Viscount Melville Sound, Lancaster Sound, Norwegian Bay, Kane Basin, Baffin Bay, and Davis Strait. A north–south substructure was identified for the Baffin Bay population, but it was weaker than the structure identified for the 6 primary units. The 6 units were consistent with genetic information, except for the Baffin Bay – Kane Basin separation, and with mark–recapture observations and the traditional knowledge of Inuit hunters. Only 2 of 65 bears that provided telemetry information for more than 1 year were classified in different populations in different years. However, annual rates of exchange, measured as the percentage of locations outside the population boundary, ranged from 0.4 to 8.9%. Analysis of mark–recapture movements indicated no difference in large-scale movements between the sexes or long-term movements with age. Although our validation criteria for demographic closure were satisfied, the observed rates of exchange between adjacent populations suggest that population dynamics in adjacent populations may not be completely independent.