Computer-based Prompt's impact on postural variability and sit-stand desk usage behavior; a cluster randomized control trial

Sit-to-stand workstations have been deployed in office environments to reduce sedentary behavior and improve worker's health. However, efforts to initiate and sustain long-term usage of sit-stand workstations has been a challenge, with primarily anecdotal evidence suggesting many employees cease using their sit-stand workstations once the newness diminishes. To objectively determine sit-stand workstation usage and what impact computer-based prompts would have on sit-stand desk use and sustainability, 200 office workers (118 control and 82 treatment) in two different geographic locations were continuously monitored over a 4 ½ month period, which consisted of a 6-week baseline and a 3-month experimental period. During the 3-month experimental period, computer-based prompts elicited a 229% increase in daily standing transitions which was sustained over the entire 3 months with 40% of the participants adhering to a pre-determined sit to stand schedule. These findings indicate that the use of computer-based prompts can be used to motivate employees to change their behavior regarding the use of sit-to-stand workstations.

Sit-Stand Desk Software Can Now Monitor and Prompt Office Workers to Change Health Behaviors

OBJECTIVE

To determine the effectiveness of a computer-based intervention designed to increase sit-stand desk usage and help reverse workplace physical inactivity.

BACKGROUND

Sit-stand desks have been successful in reducing workplace sedentary behavior, but the challenge remains for an effective method to increase the usage in order to experience the health and productivity benefits.

METHOD

Data collection (1-year field study with 194 workers) used a novel method of computer software that continuously recorded objective electric sit-stand desk usage, while taking into account the time a worker spends away from their desk (breaks, meetings). During the baseline period, all workers' desk usage was recorded by the software, and the intervention period consisted of software reminders and real-time feedback to all workers to change desk positions. Pooled means were calculated to determine desk usage patterns, and effect sizes and pairwise mean differences were analyzed to test for intervention significance.

RESULTS

The intervention doubled desk usage by increasing ~1 change to ~2 changes per work day. There was a 76% reduction in workers who never used the sit-stand function of the desk. Medium to large effect sizes from the intervention were observed in all three primary outcome measures (desk in sitting/standing position and desk position changes per work day).

CONCLUSION

These findings demonstrate an effective intervention that increased postural transitioning and interrupted prolonged inactivity while remaining at the workstation.

APPLICATION

The methods and results in this research study show that we can quantify an increase in desk usage and collect aggregate data continuously.

Smart Software Can Increase Sit-Stand Desk Transitions During Active Computer Use

The objective use of table top adjustable sit-stand desks has yet to be determined, due to the lack of an effective digital evaluation method. The objective of this study was to evaluate the impact of computer prompt software on table top sit-stand desks to determine if there was a difference in the frequency of desk position changes. This five month, pre-post pilot study on 47 university staff members used a novel USB accelerometer sensor and computer software reminders to continuously record and prompt increases in desk usage to promote physical activity at the workstation. During the baseline phase (3 months), desk usage data were continuously recorded for all workers. Following the baseline, the results from a two-month intervention of personalized computer reminders doubled the number of desk position changes per work day from 1 desk position change every 2 work days to 1 change every work day. Furthermore, those who changed desk positions once or twice a day increased from 4% to 36% from baseline to intervention. Overall, the intervention was encouraging, but longer intervention studies are warranted to determine if the desk usage behavior change can be improved and sustained for years and whether that change results in health gains.

The effect of cognitive fatigue on prefrontal cortex correlates of neuromuscular fatigue in older women

BACKGROUND

As the population of adults aged 65 and above is rapidly growing, it is crucial to identify physical and cognitive limitations pertaining to daily living. Cognitive fatigue has shown to adversely impact neuromuscular function in younger adults, however its impact on neuromuscular fatigue, and associated brain function changes, in older adults is not well understood. The aim of the study was to examine the impact of cognitive fatigue on neuromuscular fatigue and associated prefrontal cortex (PFC) activation patterns in older women.

METHODS

Eleven older (75.82 (7.4) years) females attended two sessions and performed intermittent handgrip exercises at 30 % maximum voluntary contraction (MVC) until voluntary exhaustion after a 60-min control (watching documentary) and 60-min cognitive fatigue (performing Stroop Color Word and 1-Back tests) condition. Dependent measures included endurance time, strength loss, PFC activity (measured using fNIRS), force fluctuations, muscle activity, cardiovascular responses, and perceived discomfort.

RESULTS

Participants perceived greater cognitive fatigue after the 60-min cognitive fatigue condition when compared to the control condition. While neuromuscular fatigue outcomes (i.e., endurance time, strength loss, perceived discomfort), force fluctuations, and muscle activity were similar across both the control and cognitive fatigue conditions, greater decrements in PFC activity during neuromuscular fatigue development after the cognitive fatigue condition were observed when compared to the control condition.

CONCLUSION

Despite similar neuromuscular outcomes, cognitive fatigue was associated with blunted PFC activation during the handgrip fatiguing exercise that may be indicative of neural adaptation with aging in an effort to maintain motor performance. Examining the relationship between cognitive fatigue and neuromuscular output by imaging other motor-related brain regions are needed to provide a better understanding of age-related compensatory adaptations to perform daily tasks that involve some levels of cognitive demand and physical exercise, especially when older adults experience them sequentially.

Bile acid aspiration associated with lung chemical profile linked to other biomarkers of injury after lung transplantation

Aspiration of gastrointestinal contents has been linked to worse outcomes following lung transplantation but uncertainty exists about underlying mechanisms. We applied high-resolution metabolomics of bronchoalveolar lavage fluid (BALF) in patients with episodic aspiration (defined by bile acids in the BALF) to identify potential metabolic changes associated with aspiration. Paired samples, one with bile acids and another without, from 29 stable lung transplant patients were studied. Liquid chromatography coupled to high-resolution mass spectroscopy was used to interrogate metabolomic contents of these samples. Data were obtained for 7068 ions representing intermediary metabolites, environmental agents and chemicals associated with microbial colonization. A substantial number (2302) differed between bile acid positive and negative samples when analyzed by false discovery rate at q = 0.01. These included pathways associated with microbial metabolism. Hierarchical cluster analysis defined clusters of chemicals associated with bile acid aspiration that were correlated to previously reported biomarkers of lung injury including T cell granzyme B level and the chemoattractants CXCL9 and CXCL10. These data specifically link bile acids presence in lung allografts to inflammatory pathways known to segregate with worsening allograft outcome, and provide additional mechanistic insight into the association between reflux and lung allograft injury.

Ergonomics principles associated with laparoscopic surgeon injury/illness

OBJECTIVE

This study sought to investigate the prevalence of laparoscopic surgeon injury/illness symptoms and evaluate associations between symptoms and operating room ergonomics.

BACKGROUND

Although laparoscopic procedures significantly benefit patients in terms of decreased recovery times and improved outcomes, they contribute to mental fatigue and musculoskeletal problems among surgeons. A variety of ergonomic interventions and applications are implemented by surgeons to reduce health problems. Currently, there is a gap in knowledge regarding a surgeon's individual assessment of the operating room, an assessment that, in turn, would prompt the implementation of these interventions.

METHOD

A new survey instrument solicited information from surgeons (N = 61) regarding surgeon demographics, perception, frequency of operating room equipment adjustment, and self-reported symptoms. Surgeons responded to questions addressing safety, ergonomics, and fatigue in the operating room, using a 5-point Likert-type scale that included the option undecided.

RESULTS

Surgeons who responded undecided were more likely to experience symptoms of injury/illness than respondents who were able to assess the features of their operating rooms. Symptoms were experienced by 100% of participants. The most prevalent symptoms were neck stiffness, back stiffness, and back pain.

CONCLUSION

This study supports hypotheses that surgeons are experiencing body part discomfort and indicators of fatigue that may be associated with performing laparoscopy. Results suggest that awareness, knowledge, and utilization of ergonomic principles could protect surgeons against symptoms that lead to occupational injury.

APPLICATION

The purpose of this brief report is to convey the importance of ergonomic principles in the operating room, specific to laparoscopic surgery and surgeon injury/illness symptoms.

Cumulative exposure to gamma interferon-dependent chemokines CXCL9 and CXCL10 correlates with worse outcome after lung transplant

Outcomes following lung transplant are suboptimal owing to chronic allograft failure termed bronchiolitis obliterans syndrome (BOS). Prior work in both mice and humans has shown that interferon gamma (IFNG)-induced chemokines, including CXCL9 and CXCL10, are elevated in patients with established BOS. We hypothesized that patients who ultimately developed BOS would have elevations in these chemokines before losing lung function. We utilized a high throughput multiplex enzyme-linked immunosorbent assay (ELISA) to measure biomarkers in bronchoalveolar lavage fluid (BALF). We modeled cumulative exposure to seven biomarkers (CXCL9, CXCL10, RANTES, IL1-RA, IL-17, MCP1 and IL-13) by calculating the 1-year area under the curve (AUC) for each biomarker in the BALF of 40 lung transplant patients who had at least four samples obtained in the first year posttransplant. Cumulative elevations in CXCL9 and CXCL10 were associated with a significant risk of subsequent graft failure after transplant (HR 9.37 and 5.52, respectively; p < 0.01 for both). Further these chemokines were also elevated in patients before the onset of BOS. CXCL9 and CXCL10 elevations were seen between 3 and 9 months before graft failure. Our data show that persistent presence of CXCL9 and CXCL10 portents worsening lung allograft function; measuring these IFNG-induced chemokines might prospectively identify patients at risk for BOS.

Preoperative chemoradiation and postoperative adjuvant tetrathiomolybdate for patients with resectable esophageal cancer

e15504

Background: Tetrathiomolybdate (TM) is an oral copper chelator. Copper is necessary for blood vessel growth, and so TM functions as an antiangiogenic agent. Methods: Pts with resectable esophageal cancer were treated at the University of Michigan with chemoradiation followed by surgery, and then 2 years of TM. Chemoradiation was cisplatin 60 mg/m2 on days #1 and 22, paclitaxel 60 mg/m2 on days #1, 8, 15, and 22, and radiation 1.5 Gy fractions b.i.d. x 3 weeks to a total of 45 Gy. Transhiatal esophagectomy was performed on approximately day #50. TM 20 mg p.o. q.d. was started approximately 4 weeks post-op, and continued for 2 years. Doses were adjusted to maintain the ceruloplasmin level between 5 and 15. Results: Between 1/23/02 and 1/24/06, 69 pts were enrolled. Pt characteristics: males - 62 (90%), females - 7 (10%); median age - 60 (range 42–74); adenocarcinoma - 56 (81%), squamous cell carcinoma 13 (19%). The chemoradiation was well tolerated: grade 3 leukopenia in 15 pts (22%), and 17 pts (25%) required feeding tubes. 66 pts went to surgery. 61 pts had a complete resection; 4 pts had metastases discovered at surgery, and 1 pt had extensive positive margins. Histologic complete response rate was 10%. 21 pts never received TM because of metastases noted in the peri-operative period, long post-op recovery time, or pt refusal. 48 pts started TM after surgery and it was well tolerated. Grade 3 toxicities were diarrhea -2 (3%), nausea - 2 (3%), dizziness - 2 (3%). 13 pts completed the full 24 mos of treatment, 12 completed 10–23 mos, 15 completed 2–8 mos, and 8 completed only 1 month or less. 27 pts have had disease recurrence, the majority (23 of the 27) of which was distant. Current status of pts with median follow-up time of 55 months: 25 alive and disease-free, 1 alive with disease, and 43 have died. 3-year survival probability is 47% (95% CI 35%-58.6%). 3-year recurrence-free probability is 51% (95% CI 38%- 62.7%). Conclusions: TM is an antiangiogenic agent which is fairly well tolerated. Prolonged adjuvant treatment over 2 years is difficult but not impossible to complete. Disease-free survival and overall survival are promising when compared to historical controls treated with a very similar chemoradiation regimen without TM in the past at the University of Michigan.

[Table: see text]

The finished DNA sequence of human chromosome 12

Human chromosome 12 contains more than 1,400 coding genes and 487 loci that have been directly implicated in human disease. The q arm of chromosome 12 contains one of the largest blocks of linkage disequilibrium found in the human genome. Here we present the finished sequence of human chromosome 12, which has been finished to high quality and spans approximately 132 megabases, representing approximately 4.5% of the human genome. Alignment of the human chromosome 12 sequence across vertebrates reveals the origin of individual segments in chicken, and a unique history of rearrangement through rodent and primate lineages. The rate of base substitutions in recent evolutionary history shows an overall slowing in hominids compared with primates and rodents.

Fast-tracking pulmonary resections

OBJECTIVE

We streamlined our care after pulmonary resection for quality and cost-effectiveness.

METHODS

A single surgeon performed 500 consecutive pulmonary resections through a thoracotomy over a 2(3/4)-year period in a university setting. Patients were extubated in the operating room and sent directly to their hospital room. Chest tubes were placed to water seal and removed on postoperative day 2 if there was no air leak and drainage was less then 400 mL/d. Epidural catheters were used and removed by postoperative day 2. The plan for each day and discharge on postoperative day 3 or 4 was reviewed with the patients and families daily during rounds. The patient went home the day the last chest tube was removed. Persistent air leaks were treated with Heimlich valves.

RESULTS

There were 500 patients (338 men), with a median age of 58 years (range, 3-87 years). Of these patients, 293 had pre-existing conditions. Seventy-three (15%) patients had been denied operations by at least one other surgeon. Four hundred nineteen (84%) patients had successful placement of a functioning preoperative epidural catheter. Pneumonectomy was performed in 32 (6%) patients, segmentectomy was performed in 16 (3%) patients, and lobectomy, sleeve lobectomy, and/or bilobectomy was performed in 194 (39%) patients. Nonanatomic resections were performed for metastasectomy. This included a single wedge resection in 161 (32%) patients and multiple wedge resections in 97 (19%) patients. A total of 482 (96%) patients were extubated in the operating room, and 380 (76%) patients were sent to their hospital room. The remaining 120 patients went to the intensive care unit for a median of 1 day (range, 1-41 days). Complications occurred in 107 (21%) patients, and operative mortality was 2.0%. Median day of discharge was postoperative day 4 (range, 2-119 days). A total of 327 (65%) patients left the hospital on postoperative day 4 or sooner. By survey, 97% of patients had excellent or good satisfaction with their care at hospital discharge, and 91% were extremely happy or satisfied at the 2-week follow-up contact.

CONCLUSIONS

Most patients who undergo elective pulmonary resection can be extubated immediately after the operation, go directly to their room and avoid the intensive care unit, be discharged on postoperative day 3 or 4, and have minimal morbidity and mortality with high satisfaction both at discharge and at the 2-week follow-up contact. Techniques that seem to accomplish this include the following: the use of a water seal, removal of epidural catheters on postoperative day 2, early chest tube management, treatment of persistent air leaks with Heimlich valves, and daily reinforcement of the planned events for each day, as well as on the date of discharge with the patients and their families.

Apoptosis and tumorigenesis in human cholangiocarcinoma cells. Involvement of Fas/APO-1 (CD95) and calmodulin

We have previously demonstrated that tamoxifen inhibits the growth of human cholangiocarcinoma cells in culture and inhibits tumor growth when cells are injected into nude mice. However, the mechanism of action of tamoxifen remains unknown. Here we demonstrate that tamoxifen and trifluoperazine, both potent calmodulin antagonists, induce apoptosis in vitro, probably acting via the Fas system, in human cholangiocarcinoma cells. Human cholangiocarcinoma cell lines heterogeneously express Fas antigen on their surface. Fas-negative and Fas-positive surface-expressing cells were isolated, cloned, and cultured. Fas antibody, tamoxifen, and trifluoperazine induced dose-dependent apoptosis only in Fas-positive cells; Fas-negative cells were unaffected. Furthermore, apoptosis induced by tamoxifen in Fas-positive cells was blocked by an inhibitory Fas antibody. Tamoxifen was not acting through an anti-estrogenic mechanism, because neither Fas-negative nor Fas-positive cells expressed estrogen receptors and the pure anti-estrogen compound, ICI 182780, did not induce apoptosis in either cell line. Fas-negative cells, but not Fas-positive cells, were able to produce tumors when subcutaneously injected into nude mice. These findings suggest Fas may be a candidate oncogene involved in the pathogenesis of cholangiocarcinoma. Furthermore, the similarity between the pro-apoptotic effects of tamoxifen and trifluoperazine support an underlying molecular mechanism for Fas-mediated apoptosis that involves calmodulin.

Fas expression prevents cholangiocarcinoma tumor growth

Cholangiocarcinoma continues to have a dismal prognosis with an overall survival rate of less than 10%. An increased understanding of the molecular oncogenesis of this tumor is needed. Fas/APO-1 (CD95) receptor and Fas ligand have been implicated as key factors in apoptosis. In this study we have examined the role of the Fas receptor in the growth of cholangiocarcinoma. The purpose of this study was to evaluate the role of the Fas receptor in the induction of apoptosis in cholangiocarcinoma and to assess the role of the Fas receptor in cholangiocarcinoma tumorigenesis. Human cholangiocarcinoma cells, SK-ChA-1, were evaluated for Fas receptor expression using fluorescence-activated cell sorting (FACS). Distinct cell populations (Fas-positive and Fas-negative) were isolated by FACS and cloned from single cell dilutions. Fas expression was assessed by FACS and reverse transcriptase-polymerase chain reaction (RT-PCR). Cell populations were further characterized by their sensitivity to anti-Fas monoclonal antibody at 72 hours. Cell viability and apoptotic index were evaluated by trypan blue cell count and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) assay, respectively. Distinct cell populations were evaluated for their ability to form tumors in BALB/c nude mice (2.5 x 10(6) cells per subcutaneous injection). After 4 weeks, tumors were evaluated for tumor area by caliper measurement and Fas expression by RT-PCR. Maintenance of biliary phenotype was assured by means of AE-1 (cytokeratin) immunohistochemistry. Populations of Fas-positive and Fas-negative cells were identified, isolated, and confirmed by FACS and RT-PCR. Treatment of Fas-positive cells with anti-Fas monoclonal antibody produced an 80% reduction in cell viability compared to no decrease in viability in Fas-negative cells by trypan blue cell count. TUNEL staining showed an apoptotic index of 75% for Fas-positive cells incubated with anti-Fas monoclonal antibody and no significant evidence of apoptosis in the Fas-negative cells. When cholangiocarcinoma cells were subcutaneously injected into nude mice, only Fas-negative cells formed tumor nodules; Fas-positive cells failed to form tumor nodules. The analyzed tumors lacked Fas messenger RNA by RT-PCR but maintained the biliary cytokeratin AE-1 by immunohistochemistry. Fas receptor expression is an important mediator of apoptosis in cultured human cholangiocarcinoma cells and appears to be a critical determinant of cholangiocarcinoma tumor growth in nude mice.

An unusual etiology of biliary hilar obstruction and the potential role of acidic fibroblast growth factor in the development of a biliary neuroma

Neuroma of the biliary tract is a rare condition thought to be caused by trauma secondary to cholecystectomy. More rare is the occurrence that causes symptomatic biliary obstruction. A 65-year-old woman was hospitalized because of abdominal pain, nausea, vomiting, and general malaise of 1 to 2 months duration. Cholecystectomy had been performed 40 years before. Ultrasound revealed hepatomegaly and dilated intrahepatic ducts. CT showed intra- and extrahepatic ductal dilatation with questionable intraductal mass. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography demonstrated stricture of the hepatic duct bifurcation. The biliary bifurcation was resected, and hepaticojejunostomy was performed. The patient's postoperative course was unremarkable. Histological examination of the surgical specimen revealed positive staining for the S-100 antigen of the obstructing luminal stricture (without evidence of cholangiocarcinoma), which was consistent with a biliary neuroma. Positive staining was also found for acidic (and not basic) fibroblast growth factor (FGF) and two of its high affinity receptors (FGFR-1 and FGFR-4). This study supports the apparent association between biliary neuromas and cholecystectomy as well as the potential role of an established angiogenic and neurogenic growth factor in the formation of this tumor. Finally, this case is also unique in that it represents the longest interval between cholecystectomy and presentation of a biliary neuroma, 40 years after surgery.

Neurobehavioral symptoms and family functioning in traumatically brain-injured adults

Traumatic brain injury (TBI) often results in a myriad of symptoms across physical, cognitive, and neurobehavioral domains. Despite inherent limitations associated with physical or cognitive impairments, the extant literature suggests that neurobehavioral symptoms tend to be the most distressing symptoms for the family and are more strongly related to poor outcome for the patient. The Neuropsychology Behavior and Affect Profile (NBAP) along with the General Functioning subscale of the Family Assessment Device (FAD-GF) and the Perceived Stress Scale were administered to 153 family members of persons who had sustained a TBI. The results provide new normative data and statistical support for the NBAP as a promising measure of neurobehavioral symptomatology following TBI. The correlation of.54 (p <.01) between FAD-GF and Full Scale NBAP scores provides powerful support for the hypothesis that family dysfunction is related to the presence of neurobehavioral symptoms in the patient. NBAP domains of Depression, Inappropriateness, Pragnosia, and Indifference appear most strongly related to family functioning and also bear a significant relationship to caregiver stress level and patient unemployment, whereas injury severity had little impact on either family functioning or neurobehavioral symptoms. The findings reinforce the significance of neurobehavioral symptoms and fortify their proposed link to family dysfunction post-TBI.

Intramural pregnancy with fetal survival: case history and discussion of etiologic factors

Intramural implantation is among the rarest sites for ectopic pregnancy. The first intramural pregnancy with fetal survival is described and the possible etiologic role of prior uterine surgery is discussed.