Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review

Cesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. A growing body of research has investigated tools to predict which patients will experience more severe pain and have increased analgesic consumption after cesarean delivery. These include quantitative sensory testing, assessment of wound hyperalgesia, response to local anesthetic infiltration, and preoperative psychometric evaluations such as validated psychological questionnaires and simple screening tools. For this review, we searched MEDLINE, the Cochrane database, and Google Scholar to identify articles that evaluated the utility of various tools to predict severe pain and/or opioid consumption in the first 48 hours after cesarean delivery. Thirteen articles were included in the final review: 5 utilizing quantitative sensory testing, including patient responses to pressure, electrical, and thermal stimuli; 1 utilizing hyperalgesia testing; 1 using response to local anesthetic wound infiltration; 4 utilizing preoperative psychometric evaluations including the State-Trait Anxiety Inventory, the Pain Catastrophizing Scale, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and simple questionnaires; and 2 utilizing a combination of quantitative sensory tests and psychometric evaluations. A number of modalities demonstrated statistically significant correlations with pain outcomes after cesarean delivery, but most correlations were weak to modest, and many modalities might not be clinically feasible. Response to local anesthetic infiltration and a tool using 3 simple questions enquiring about anxiety and anticipated pain and analgesic needs show potential for clinical use, but further studies are needed to evaluate the utility of these predictive tests in clinical practice.

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A Pain in the Abs: Predicting Post-Cesarean Analgesia

No abstract available

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Physiology and Role of Intraocular Pressure in Contemporary Anesthesia

More than 26 million Americans suffer with cataracts, and with 3.6 million cataract extractions performed annually in the United States, it is the most common surgical procedure. The integrity of the delicate structures of the eye that mediate vision is dependent on the intraocular pressure (IOP). Yet, IOP acts to compress the vessels within the globe—akin to a Starling resistor—and is a key component that determines the ocular perfusion pressure, defined as the difference between arterial pressure and IOP. The retina is one of the most metabolically active tissues in the body, and its functional integrity is dependent on an adequate blood supply, with retinal function linearly related to the ocular perfusion pressure. Retinal cell death has been demonstrated at low perfusion pressures (below 50 mm Hg). Modern ophthalmic surgery involves globe irrigation, manipulation, and instrumentation, resulting in dynamic pressure fluxes within the eye. Marked elevations of IOP (up to 4–5 times the normal value) with consequent borderline retinal and optic disk perfusion pressures occur for prolonged periods during many ophthalmic procedures. General surgeries, including laparoscopic, spinal, and cardiac procedures, especially, with their demand for steep Trendelenburg or prolonged prone positioning and/or hypotensive anesthesia, can induce IOP changes and ocular perfusion imbalance. These rapid fluctuations in IOP, and so in perfusion, play a role in the pathogenesis of the visual field defects and associated ocular morbidity that frequently complicate otherwise uneventful surgeries. The exact etiology of such outcomes is multifactorial, but ocular hypoperfusion plays a significant and frequently avoidable role. Those with preexisting compromised ocular blood flow are especially vulnerable to intraoperative ischemia, including those with hypertension, diabetes, atherosclerosis, or glaucoma. However, overly aggressive management of arterial pressure and IOP may not be possible given a patient's comorbidity status, and it potentially exposes the patient to risk of catastrophic choroidal hemorrhage. Anesthetic management significantly influences the pressure changes in the eye throughout the perioperative period. Strategies to safeguard retinal perfusion, reduce the ischemic risk, and minimize the potential for expulsive bleeding must be central to the anesthetic techniques selected. This review outlines: important physiological principles; ophthalmic and general procedures most likely to develop damaging IOP levels and their causative factors; the effect of anesthetic agents and techniques on IOP; recent scientific evidence highlighting the significance of perfusion changes during surgery; and key aspects of postoperative visual loss and management approaches for high-risk patients presenting for surgery.

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The Eyes Have It: Factors that Influence Intraocular Pressure (IOP)

No abstract available

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Patient Harm in Cataract Surgery: A Series of Adverse Events in Massachusetts

Massachusetts state agencies received reports of 37 adverse events (AEs) involving cataract surgery from 2011 to 2015. Fifteen were anesthesia related, including 5 wrong eye blocks, 3 cases of hemodynamic instability, 2 retrobulbar hematoma/hemorrhages, and 5 globe perforations resulting in permanent loss of vision. While Massachusetts' reported AEs likely underrepresent the true number of AEs that occur during cataract surgery, they do offer useful signal data to indicate the types of patient harm occurring during these procedures.

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Preventing Adverse Events in Cataract Surgery: Recommendations From a Massachusetts Expert Panel

Massachusetts health care facilities reported a series of cataract surgery–related adverse events (AEs) to the state in recent years, including 5 globe perforations during eye blocks performed by 1 anesthesiologist in a single day. The Betsy Lehman Center for Patient Safety, a nonregulatory Massachusetts state agency, responded by convening an expert panel of frontline providers, patient safety experts, and patients to recommend strategies for mitigating patient harm during cataract surgery. The purpose of this article is to identify contributing factors to the cataract surgery AEs reported in Massachusetts and present the panel's recommended strategies to prevent them. Data from state-mandated serious reportable event reports were supplemented by online surveys of Massachusetts cataract surgery providers and semistructured interviews with key stakeholders and frontline staff. The panel identified 2 principal categories of contributing factors to the state's cataract surgery–related AEs: systems failures and choice of anesthesia technique. Systems failures included inadequate safety protocols (48.7% of contributing factors), communication challenges (18.4%), insufficient provider training (17.1%), and lack of standardization (15.8%). Choice of anesthesia technique involved the increased relative risk of needle-based eye blocks. The panel's surveys of Massachusetts cataract surgery providers show wide variation in anesthesia practices. While 45.5% of surgeons and 69.6% of facilities reported increased use of topical anesthesia compared to 10 years earlier, needle-based blocks were still used in 47.0% of cataract surgeries performed by surgeon respondents and 40.9% of those performed at respondent facilities. Using a modified Delphi approach, the panel recommended several strategies to prevent AEs during cataract surgery, including performing a distinct time-out with at least 2 care-team members before block administration; implementing standardized, facility-wide safety protocols, including a uniform site-marking policy; strengthening the credentialing and orientation of new, contracted and locum tenens anesthesia staff; ensuring adequate and documented training in block administration for any provider who is new to a facility, including at least 10 supervised blocks before practicing independently; using the least invasive form of anesthesia appropriate to the patient; and finally, adjusting anesthesia practices, including preferred techniques, as evidence-based best practices evolve. Future research should focus on evaluating the impact of these recommendations on patient outcomes.

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Splicing mutations in human genetic disorders: examples, detection, and confirmation

Abstract

Precise pre-mRNA splicing, essential for appropriate protein translation, depends on the presence of consensus "cis" sequences that define exon-intron boundaries and regulatory sequences recognized by splicing machinery. Point mutations at these consensus sequences can cause improper exon and intron recognition and may result in the formation of an aberrant transcript of the mutated gene. The splicing mutation may occur in both introns and exons and disrupt existing splice sites or splicing regulatory sequences (intronic and exonic splicing silencers and enhancers), create new ones, or activate the cryptic ones. Usually such mutations result in errors during the splicing process and may lead to improper intron removal and thus cause alterations of the open reading frame. Recent research has underlined the abundance and importance of splicing mutations in the etiology of inherited diseases. The application of modern techniques allowed to identify synonymous and nonsynonymous variants as well as deep intronic mutations that affected pre-mRNA splicing. The bioinformatic algorithms can be applied as a tool to assess the possible effect of the identified changes. However, it should be underlined that the results of such tests are only predictive, and the exact effect of the specific mutation should be verified in functional studies. This article summarizes the current knowledge about the "splicing mutations" and methods that help to identify such changes in clinical diagnosis.

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Overinduction of the CYP51A Gene After Exposure to Azole Antifungals Provides a First Clue to the Resistance Mechanism in the Fusarium solani Species Complex

Microbial Drug Resistance, Ahead of Print.


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Can Subminimal Inhibitory Concentrations of Antibiotics Induce the Formation of Biofilm in Leptospira?

Microbial Drug Resistance, Ahead of Print.


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Comment on “Lumbar MRI Findings in Guillain-Barré Syndrome”

We read with interest the paper by Resorlu et al [1] about a 13-year-old boy who developed a rapidly worsening neurologic disease with postinfectious ascending limb weakness, depressed jerks, and high proteins in spinal fluid. Lumbar magnetic resonance imaging (MRI) showed contrast enhancement (CE) of roots in the cauda equina and the conus medullaris, suggesting that both anterior and posterior roots were involved [1]. The preliminary diagnosis was Guillain-Barré syndrome (GBS) [1]. In Resorlu et al's study [1], no comments are provided regarding electrophysiological changes, treatments, and the neurologic follow-up of their patient.

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“Text-neck”: an epidemic of the modern era of cell phones?

We would like to thank the authors of the article " 'Text-neck': an epidemic of the modern era of cell phones?" for highlighting a new behavior that is hypothesized to cause musculoskeletal consequences. We agree that there has been a potentially harmful increased use of, and addiction to, mobile phones for texting combined with the growing prevalence of neck pain [1–4].

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Table of Contents

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Editorial Board

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Meetings Calendar

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Clinical utility of the Oswestry Disability Index for measuring the function of patients with low back pain

We are writing in response to Dr Darrel Brodke et al.'s article "Oswestry Disability Index: a Psychometric Analysis with 1,610 Patients," The Spine Journal 2017;17:321–327. The purpose of the paper was to investigate the psychometric properties, performance, and clinical applicability of the Oswestry Disability Index (ODI) for assessing function in patients with low back pain using Rasch Item Response Theory methods.

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In Response

No abstract available

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Differential Effects of Anesthetics and Opioid Receptor Activation on Cardioprotection Elicited by Reactive Oxygen Species–Mediated Postconditioning in Sprague-Dawley Rat Hearts

BACKGROUND: Despite an array of cardioprotective interventions identified in preclinical models of ischemia–reperfusion (IR) injury, successful clinical translation has not been achieved. This study investigated whether drugs routinely used in clinical anesthesia influence cardioprotective effectiveness by reducing effects of reactive oxygen species (ROS), upstream triggers of cardioprotective signaling. Effects of propofol, sevoflurane, or remifentanil were compared on postischemic functional recovery induced by ROS-mediated postconditioning with Intralipid. METHODS: Recovery of left ventricular (LV) work, an index of IR injury, was measured in isolated Sprague-Dawley rat hearts subjected to global ischemia (20 minutes) and reperfusion (30 minutes). Hearts were either untreated or were treated with postconditioning with Intralipid (1%, throughout reperfusion). Propofol (10 μM), sevoflurane (2 vol%), remifentanil (3 nM), or combinations thereof were administered peri-ischemically (before and during IR). The effects of anesthetics on ROS production were measured in LV cardiac fibers by Amplex Red assay under phosphorylating and nonphosphorylating conditions. RESULTS: Recovery of LV work (expressed as percentage of the preischemic value ± standard deviation) in untreated hearts was poor (20% ± 7%) and was improved by Intralipid postconditioning (58% ± 8%, P = .001). In the absence of Intralipid postconditioning, recovery of LV work was enhanced by propofol (28% ± 9%, P = .049), sevoflurane (49% ± 5%, P

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A Pain in the Abs: Predicting Post-Cesarean Analgesia

No abstract available

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Delineating the Trajectory of Cognitive Recovery From General Anesthesia in Older Adults: Design and Rationale of the TORIE (Trajectory of Recovery in the Elderly) Project

BACKGROUND: Mechanistic aspects of cognitive recovery after anesthesia and surgery are not yet well characterized, but may be vital to distinguishing the contributions of anesthesia and surgery in cognitive complications common in the elderly such as delirium and postoperative cognitive dysfunction. This article describes the aims and methodological approach to the ongoing study, Trajectory of Recovery in the Elderly (TORIE), which focuses on the trajectory of cognitive recovery from general anesthesia. METHODS: The study design employs cognitive testing coupled with neuroimaging techniques such as functional magnetic resonance imaging, diffusion tensor imaging, and arterial spin labeling to characterize cognitive recovery from anesthesia and its biological correlates. Applying these techniques to a cohort of age-specified healthy volunteers 40–80 years of age, who are exposed to general anesthesia alone, in the absence of surgery, will assess cognitive and functional neural network recovery after anesthesia. Imaging data are acquired before, during, and immediately after anesthesia, as well as 1 and 7 days after. Detailed cognitive data are captured at the same time points as well as 30 days after anesthesia, and brief cognitive assessments are repeated at 6 and 12 months after anesthesia. RESULTS: The study is underway. Our primary hypothesis is that older adults may require significantly longer to achieve cognitive recovery, measured by Postoperative Quality of Recovery Scale cognitive domain, than younger adults in the immediate postanesthesia period, but all will fully recover to baseline levels within 30 days of anesthesia exposure. Imaging data will address systems neuroscience correlates of cognitive recovery from general anesthesia. CONCLUSIONS: The data acquired in this project will have both clinical and theoretical relevance regardless of the outcome by delineating the mechanism behind short-term recovery across the adult age lifespan, which will have major implications for our understanding of the effects of anesthetic drugs.

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Auditing Intraoperative Transfusions to Promote High-Value Perioperative Care

No abstract available

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Treatment of Chronic Pain Conditions: A Comprehensive Handbook

No abstract available

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Postoperative Troponin Elevation, Myocardial Injury, and Pulmonary Embolism

No abstract available

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In Response

No abstract available

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The American College of Surgeons Children’s Surgery Verification and Quality Improvement Program: Be Careful What You Wish For!

No abstract available

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Effect of Stellate Ganglion Block on the Regional Hemodynamics of the Upper Extremity: A Randomized Controlled Trial

BACKGROUND: The success of stellate ganglion block (SGB) is traditionally determined on the basis of findings such as Horner's syndrome, temperature rise in the face, hyperemia of the tympanic membrane, and nasal congestion. However, decreases in vascular resistance and increases in blood flow in the arm may be more meaningful findings. To date, the effect of SGB on the regional hemodynamics of the arm has not been evaluated using pulsed-wave Doppler ultrasound. METHODS: A total of 52 patients who were to undergo orthopedic surgery of the forearm were randomly assigned to either the mepivacaine group (SGB with 5 mL of 0.5% mepivacaine) or the saline group (SGB with 5 mL of normal saline). Before surgery, a single anesthesiologist performed a SGB under ultrasound guidance. The temperature of the upper extremity and the resistance index and blood flow in the brachial artery were measured before SGB, 15 and 30 minutes after SGB, and 1 hour after surgery. The severity of pain, requirement for rescue analgesics, and side effects of the local anesthetic agent were all documented. RESULTS: After SGB, the resistance index decreased significantly and the blood flow increased significantly in the brachial artery of members of the mepivacaine group (15 minutes: P = .004 and P

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The Pros of Publishing Standalone Clinical Trial Protocols in Anesthesiology Journals

No abstract available

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Can Lung Ultrasound Be the First-Line Tool for Evaluation of Intraoperative Hypoxemia?

No abstract available

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Publishing Methods Without Results: A First That Hopefully Will Not Last

No abstract available

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Pain Medicine: An Essential Review

No abstract available

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The Eye: What You Don’t Know Can Hurt Your Patient

No abstract available

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Renal Interstitial Exhaustion and SGLT2 Blockers

No abstract available

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Looking Beyond the Pain: Can Effective Labor Analgesia Prevent the Development of Postpartum Depression?

No abstract available

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Perioperative Cardiac Arrest: Focus on Local Anesthetic Systemic Toxicity (LAST) Erratum

No abstract available

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Testing Times: Routine to Indicated!

No abstract available

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Teaching Medical Students Clinical Anesthesia

There are many reasons for evaluating our approach and improving our teaching of America's future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are allowed full access to patient care, including performing history and physical examinations, participating in the insertion of IVs and airway management. Simulation-based teaching was used by 82% of programs during medical student anesthesia clerkships. Sixty-eight percent of respondents reported that they have no formal training for their anesthesiology faculty teachers, 51% stated that they do not receive nonclinical time to teach, and 38% of respondents stated that they received some form of remuneration for teaching medical students, primarily nonclinical time. This article presents a summary of these survey results, provides a historical review of previous evaluations of teaching medical students clinical anesthesia, and discusses the contributions of anesthesiologists to medical student education.

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An RNAi Screen Identifies New Genes Required for Normal Morphogenesis of Larval Chordotonal Organs

The proprioceptive chordotonal organs (ChO) of a fly larva respond to mechanical stimuli generated by muscle contractions and consequent deformations of the cuticle. The ability of the ChO to sense the relative displacement of its epidermal attachment sites likely depends on the correct mechanical properties of the accessory (cap and ligament) and attachment cells that connect the sensory unit (neuron and scolopale cell) to the cuticle. The genetic programs dictating the development of ChO cells with unique morphologies and mechanical properties are largely unknown. Here we describe an RNAi screen that focused on the ChO's accessory and attachment cells and was performed in 2^nd instar larvae to allow for phenotypic analysis of ChOs that had already experienced mechanical stresses during larval growth. Nearly one thousand strains carrying RNAi constructs targeting more than 500 candidate genes were screened for their effects on ChO morphogenesis. The screen identified 31 candidate genes whose knockdown within the ChO lineage disrupted various aspects of cell fate determination, cell differentiation, cellular morphogenesis and cell-cell attachment. Most interestingly, one phenotypic group consisted of genes that affected the response of specific ChO cell types to developmental organ stretching, leading to abnormal pattern of cell elongation. The 'cell elongation' group included the transcription factors Delilah and Stripe, implicating them for the first time in regulating the response of ChO cells to developmental stretching forces. Other genes found to affect the pattern of ChO cell elongation, such as α-tub85E, β1-tub, TBCE, CG8258, mys, rac and shortstop, represent putative effectors that link between cell-fate determinants and the realization of cell-specific mechanical properties.

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Comments on ‘Comments on “Modeling Cell Survival after Photon Irradiation Based on Double-Strand Break Clustering in Megabase Pair Chromatin Loops” by Thomas Friedrich, Marco Durante and Michael Scholz (Radiat Res 2012; 178:385–94)’

Radiation Research, Volume 189, Issue 5, Page 549-549, May 2018.


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Comments on “Modeling Cell Survival after Photon Irradiation Based on Double-Strand Break Clustering in Megabase Pair Chromatin Loops” by Thomas Friedrich, Marco Durante and Michael Scholz (Radiat Res 2012; 178:385–94)

Radiation Research, Volume 189, Issue 5, Page 548-549, May 2018.


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Ky. fire dept. seeking grant for firefighter, EMS body armor

The department is asking for a $44,600 Homeland Security grant to purchase body armor responders can wear during incidents where responders might be in danger

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Automatic ictal onset source localization in presurgical epilepsy evaluation

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Johannes Koren, Gerhard Gritsch, Susanne Pirker, Johannes Herta, Hannes Perko, Tilmann Kluge, Christoph Baumgartner
ObjectiveTo test the diagnostic accuracy of a new automatic algorithm for ictal onset source localization (IOSL) during routine presurgical epilepsy evaluation following STARD (Standards for Reporting of Diagnostic Accuracy) criteria.MethodsWe included 28 consecutive patients with refractory focal epilepsy (25 patients with temporal lobe epilepsy (TLE) and 3 with extratemporal epilepsy) who underwent resective epilepsy surgery. Ictal EEG patterns were analyzed with a novel automatic IOSL algorithm. IOSL source localizations on a sublobar level were validated by comparison with actual resection sites and seizure free outcome 2 years after surgery.ResultsSensitivity of IOSL was 92.3% (TLE: 92.3%); specificity 60% (TLE: 50%); positive predictive value 66.7% (TLE: 66.7%); and negative predictive value 90% (TLE: 85.7%). The likelihood ratio was more than ten times higher for concordant IOSL results as compared to discordant results (p = 0.013).ConclusionsWe demonstrated the clinical feasibility of our IOSL approach yielding reasonable high performance measures on a sublobar level.SignificanceOur IOSL method may contribute to a correct localization of the seizure onset zone in temporal lobe epilepsy and can readily be used in standard epilepsy monitoring settings. Further studies are needed for validation in extratemporal epilepsy.



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Ky. fire department requests grant for body armor

The department is asking for a $44,600 Homeland Security grant to purchase body armor firefighters can wear during incidents where responders might be in danger

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3 reasons to attend the EMS PRO conference

Keep up with the latest best practices and learn from EMS experts, vendors and peers at the annual conference and trade show

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PharmGKB summary: atazanavir pathway, pharmacokinetics/pharmacodynamics

No abstract available

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A retrospective investigation of HLA-B*5801 in hyperuricemia patients in a Han population of China

Background Hyperuricemia and gout have become increasingly prevalent in China. Allopurinol is an effective urate-lowering therapy, but it has severe side effects. HLA-B*5801 is highly associated with the allopurinol-induced toxic epidermal necrolysis and Stevens–Johnson syndrome. Patients and methods In this retrospective report, we had genotyped HLA-B*5801 in 253 cases of hyperuricemia and gout patients in a Han population in Shenzhen and analyzed the clinical management of medications. Results We found 30 carriers of the HLA-B*5801 allele in 253 cases of hyperuricemia or gout patients in the population (11.9%). Allopurinol was prescribed in both HLA-B*5801-positive and HLA-B*5801-negative groups. The evaluation of four models with or without genetic screening and management of allopurinol or febuxostat indicated that the HLA-B*5801 screening had significant cost benefit for clinical management. Conclusion For appropriate management and cost-effectiveness, the HLA-B*5801 allele should be screened in all patients with hyperuricemia and gout in the Chinese population.

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Re: The recent paper ‘Genetic determinants of impaired awareness of hypoglycaemia in type 1 diabetes’

No abstract available

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PharmGKB summary: very important pharmacogene information for ABCG2 Erratum

No abstract available

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Early foraging life: spatial and temporal aspects of landmark learning in the ant Cataglyphis noda

Abstract

Within the powerful navigational toolkit implemented in desert ants, path integration and landmark guidance are the key routines. Here, we use cue-conflict experiments to investigate the interplay between these two routines in ants, Cataglyphis noda, which start their foraging careers (novices) with learning walks and are then tested at different stages of experience. During their learning walks, the novices take nest-centered views from various directions around the nest. In the present experiments, these learning walks are spatially restricted by arranging differently sized water moats around the nest entrance and thus, limiting the space available around the nest and the nest-feeder route. First, we show that the ants are able to return to the nest by landmark guidance only when the novices have had enough space around the nest entrance for properly performing their learning walks. Second, in 180° cue-conflict situations between path integration and landmark guidance, path integration dominates in the beginning of foraging life (after completion of the learning walks), but with increasing numbers of visits to a familiar feeder landmark guidance comes increasingly into play.

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Effects of training intensity in electromyostimulation on human skeletal muscle

Abstract

Purpose

High-intensity neuromuscular electrical stimulation (NMES) training can induce muscle hypertrophy at the whole muscle and muscle fiber levels. However, whether low-intensity NMES training has a similar result is unknown. This study aimed to investigate whether low-intensity NMES training could elicit muscle hypertrophy at the whole muscle and muscle fiber levels in the human skeletal muscle.

Methods

Eight untrained young males were subjected to 18 min of unilateral NMES training for 8 weeks. One leg received NMES at maximal tolerable intensity (HIGH); the other leg received NMES at an intensity half of that in the HIGH condition (LOW). Quadriceps muscle thickness (MT), muscle fiber cross-sectional area (CSA), and knee extension strength were measured before and after the training period.

Results

The average training intensity throughout the intervention period in the HIGH and LOW conditions were 62.5 ± 4.6% maximal voluntary contraction (MVC) and 32.6 ± 2.6% MVC, respectively. MT, CSA, and muscle strength increased in both exercise conditions (p < 0.05); however, training effects in the LOW condition were lower than those in the HIGH condition (p < 0.05). The average training intensity showed a positive correlation with percent changes in muscle strength (r = 0.797, p = 0.001), MT (r = 0.876, p = 0.001), type I fiber CSA (r = 0.730, p = 0.01), and type II fiber CSA (r = 0.899, p = 0.001).

Conclusions

Low-intensity NMES could increase MT, muscle fiber CSA, and muscle strength in healthy human skeletal muscles. However, the magnitude of increase is lower in low-intensity than in high-intensity NMES training.

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Newborn Resuscitation Skills in Health Care Providers at a Zambian Tertiary Center, and Comparison to World Health Organization Standards

BACKGROUND: Birth asphyxia is a leading cause of early neonatal death. In 2013, 32% of neonatal deaths in Zambia were attributable to birth asphyxia and trauma. Basic, timely interventions are key to improving outcomes. However, data from the World Health Organization suggest that resuscitation is often not initiated, or is conducted suboptimally. Currently, there are little data on the quality of newborn resuscitation in the context of a tertiary center in a lower–middle income country. We aimed to measure the competencies of clinical practitioners responsible for newborn resuscitation. METHODS: This observational study was conducted over 5 months in Zambia. Health care professionals were recruited from anesthesia, pediatrics, and midwifery. Newborn skills and knowledge were examined using the following: (1) multiple-choice questions; (2) a ventilation skills test; and (3) 2 low–medium fidelity simulation scenarios. Participant demographics including previous resuscitation training and a self-efficacy rating score were noted. The primary outcome examined performance scores in a simulated scenario, which assessed the care of a newborn that failed to respond to basic interventions. Secondary outcome measures included apnea times after delivery and performance in the other assessments. RESULTS: Seventy-eight participants were enrolled into the study (13 physician anesthesiology residents, 13 pediatric residents, and 52 midwives). A significant difference in interprofessional performance was observed when examining checklist scores for the unresponsive newborn simulated scenario (P = .006). The median (quartiles) checklist score (out of 18) was 14.0 (13.0–14.75) for the anesthesiologists, 11.0 (8.5–12.3) for the pediatricians, and 10.8 (8.3–13.9) for the midwives. A score of 14 or more was required to pass the scenario. There was no significant difference in performance between participants with and without previous newborn resuscitation training (P = .246). The median (quartiles) apnea time after delivery was significantly different between all groups (P = .01) with anesthetic and pediatric residents performing similarly, 61 (37–97) and 63 (42.5–97.5) seconds, respectively. The midwifery participants displayed a significantly longer apnea time, 93.5 (66.3–129) seconds. Self-efficacy rating scores displayed no correlation between confidence level and the primary outcome, Spearman coefficient 0.06 (P = .55). CONCLUSIONS: Newborn resuscitation skills among health care professionals are varied. Midwives lead the majority of deliveries with anesthesiologists and pediatricians only being present at operative or high-risk births. It is therefore common that midwifery practitioners will initiate resuscitation. Despite this, midwives perform poorly when compared to anesthesia and pediatric residents. To address this discrepancy, a multidisciplinary, simulation-based newborn resuscitation program should be considered with continual clinical reenforcement of best practice. Accepted for publication February 16, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to M. Dylan Bould, MBChB, MEd, Department of Anesthesia, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Rd, Ottawa, ON, Canada. Address e-mail to dbould@cheo.on.ca. © 2018 International Anesthesia Research Society

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A Survey of Current Anesthesia Trends for Electrophysiology Procedures

BACKGROUND: There has been a dramatic shift in recent years in anesthesia coverage for electrophysiology (EP) procedures. An anesthesiologist and electrophysiologist at our institution jointly developed a survey, which was distributed to the Society of Cardiovascular Anesthesiologists and the Heart Rhythm Society. Its goal was to document current practice patterns and examine perceived variability in coverage. METHODS: On approval of the leadership from the Society of Cardiovascular Anesthesiologists and the Heart Rhythm Society, an online survey was administered to the membership. The survey included demographic data, anesthetic type, and perceptions of the respondents. RESULTS: Four hundred seventy-nine surveys were completed. Thirty-eight percent were completed by electrophysiologists and 63% by anesthesiologists, giving a response rate of 8.24% for anesthesiologists and 13.6% for electrophysiologists. Of these, 57% of respondents worked in an academic setting. Over the past 2 years, 66.5% of respondents reported anesthesia involvement in EP cases increasing. These cases are reportedly covered by all anesthesiologists in a group 55% of the time, cardiac anesthesia 32.5%, and a designated team at the remainder of the institutions. Seventy-six percent of respondents reported having designated EP block time in the schedule. Ninety-two percent of respondents reported that patient satisfaction has increased with the involvement of anesthesia services. CONCLUSIONS: Anesthesia coverage for EP procedures has continued to increase with an increase in patient satisfaction. Anesthesiologists have had to adapt and provide designated block time to accommodate this increase and also, in some instances, form teams that go beyond simply cardiac anesthesiologists to care for these patients during their procedures. Accepted for publication March 6, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Eric W. Nelson, DO, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Dr, Suite 4200, MSC 240, Charleston, SC 29425. Address e-mail to nelsonew@musc.edu. © 2018 International Anesthesia Research Society

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Pediatric Perioperative Cardiac Arrest, Death in the Off Hours: A Report From Wake Up Safe, The Pediatric Quality Improvement Initiative

BACKGROUND: Pediatric perioperative cardiac arrest (CA) is a rare but catastrophic event. This case–control study aims to analyze the causes, incidence, and outcomes of all pediatric CA reported to Wake Up Safe. Factors associated with CA and mortality after arrest are examined and possible strategies for improving outcomes are considered. METHODS: CA in children was identified from the Wake Up Safe Pediatric Anesthesia Quality Improvement Initiative, a multicenter registry of adverse events in pediatric anesthesia. Incidence, demographics, underlying conditions, causes of CA, and outcomes were extracted. Descriptive statistics and logistic regression were used to study the above factors associated with CA and mortality after CA. RESULTS: A total of531 cases of CA occurred during 1,006,685 anesthetics. CA was associated with age (odds ratio [95% confidence interval] comparing ≥6 vs

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Cerebral Small Vessel, But Not Large Vessel Disease, Is Associated With Impaired Cerebral Autoregulation During Cardiopulmonary Bypass: A Retrospective Cohort Study

BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. "Large vessel" cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. "Small vessel" cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS: Impaired autoregulation occurred in 32.4% (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2%) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25–0.86; P = .014) and higher average temperature during CPB (OR, 1.23; 95% CI, 1.02–1.475; P = .029), but not moderate-severe large cerebral arterial stenosis (P = .406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95% CI, 1.21–8.71; P = .019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS: These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation. Accepted for publication March 5, 2018. Funding: Supported in part by grant R01HL092259 from the National Institutes of Health (Principal Investigator: C.W.H.). Conflicts of Interest: See Disclosures at the end of the article. Clinical trial: NCT00981474. Reprints will not be available from the authors. Address correspondence to Charles W. Hogue, MD, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E Huron St, Feinberg 5–704, Chicago, IL 60611. Address e-mail to Charles.hogue@northwestern.edu. © 2018 International Anesthesia Research Society

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Pain Medicine Board Review

No abstract available

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In Response

No abstract available

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Opioid Oversupply After Joint and Spine Surgery: A Prospective Cohort Study

BACKGROUND: Many patients receive prescription opioids at hospital discharge after surgery, yet little is known regarding how often these opioids go unused. We estimated the prevalence of unused opioids, use of nonopioid analgesics, and storage and disposal practices after same-day and inpatient surgery. METHODS: In this prospective cohort study at a large, inner-city tertiary care hospital, we recruited individuals ≥18 years of age undergoing elective same-day or inpatient joint and spine surgery from August to November 2016. Using patient surveys via telephone calls, we assessed patient-reported outcomes at 2-day, 2-week, 1-month, and 6-month intervals, including: (1) stopping opioid treatment and in possession of unused opioid pills (primary outcome), (2) number of unused opioid tablets reported after stopping opioids, (3) use of nonopioid pain treatments, and (4) knowledge and practice regarding safe opioid storage and disposal. RESULTS: Of 141 eligible patients, 140 (99%) consented (35% taking preoperative opioids; mean age 56 years [standard deviation 16 years]; 47% women). One- and 6-month follow-up was achieved for 115 (82%) and 110 patients (80%), respectively. Among patients who stopped opioid therapy, possession of unused opioids was reported by 73% (95% confidence intervals, 62%–82%) at 1-month follow-up and 34% (confidence interval, 24%–45%) at 6-month follow-up. At 1 month, 46% had ≥20 unused pills, 37% had ≥200 morphine milligram equivalents, and only 6% reported using multiple nonopioid adjuncts. Many patients reported unsafe storage and failure to dispose of opioids at both 1-month (91% and 96%, respectively) and 6-month (92% and 47%, respectively) follow-up. CONCLUSIONS: After joint and spine surgery, many patients reported unused opioids, infrequent use of analgesic alternatives, and lack of knowledge regarding safe opioid storage and disposal. Interventions are needed to better tailor postoperative analgesia and improve the safe storage and disposal of prescription opioids. Accepted for publication February 16, 2018. Funding: This study was funded in part by the Blaustein Pain Research Fund; a "Stimulating and Advancing ACCM Research (StAAR)" grant from the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University; and the National Institute of General Medical Sciences (T32GM075774). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Mark C. Bicket, MD, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, 600 N Wolfe St, Phipps 460, Baltimore, MD 21287. Address e-mail to bicket@jhmi.edu. © 2018 International Anesthesia Research Society

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The Anesthesia Perioperative “Call for Help”—Experience at a Quaternary Pediatric Medical Center: Analysis of 67,564 Anesthesia Encounters

BACKGROUND: During the past several decades, anesthesia has become increasingly safe. Truly major adverse events are rare, and anesthesia quality researchers have instituted programs to evaluate "near miss" or less critical adverse events to evaluate the safety of anesthesia delivery. In this study, we aimed to evaluate calls for emergency help in our institution as a surrogate for pending critical events. We hypothesized that calls would be more common in patients with high American Society of Anesthesiologists (ASA) physical status, history of prematurity, and children with recent respiratory illness compared to those without these characteristics. METHODS: We analyzed emergent calls for help initiated by perioperative personnel ("STAT" calls) between August 2011 and September 2015 at Boston Children's Hospital. Our analysis had 2 phases: (1) All 193 STAT calls that occurred during this time period were analyzed for demographic variables (age, ASA physical status, gender) and specific features of the STAT calls (provider who initiated the call, anesthetic phase, presence of recent respiratory illness, location). We further categorized the STAT calls as "complicated" or "uncomplicated" based on an unexpected change in patient disposition, and analyzed how demographic factors and specific features related to the likelihood of a STAT call being complicated. (2) A subset of the total calls (108), captured after introduction of electronic intraoperative medical record in July 2012, were analyzed for the incidence of STAT calls by comparing the number and nature of the STAT calls to the number of surgical/diagnostic procedures performed. RESULTS: Univariable and multivariable analysis of the entire cohort of STAT calls (193 cases) identified several characteristics that were more likely to be associated with a complicated STAT call: higher ASA physical status; history of respiratory illness; cardiac inciting event; occurrence during induction phase of general anesthesia; postanesthesia care unit location; and calls initiated by an attending physician or a pediatric anesthesia fellow. Multivariable analysis of the subset of 108 indicated that age

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Obstructive Sleep Apnea and Postoperative Major Adverse Cardiac or Cerebrovascular Events: Was the Composite End Point Appropriate and Valid?

No abstract available

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Development and Validation of an Algorithm to Classify as Equivalent the Procedures in ICD-10-PCS That Differ Only by Laterality

BACKGROUND: The switch from International Classification of Diseases, Ninth Revision, Clinical Modification to International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for coding of inpatient procedures in the United States increased the number of procedural codes more than 19-fold, in large part due to the addition of laterality. We examined ICD-10-PCS codes for pairs of mirror-image procedures that are surgically equivalent. METHODS: We developed an algorithm in structured query language (SQL) to identify ICD-10-PCS codes differing only by laterality. We quantified the impact of laterality on the number of commonly performed major therapeutic procedures (ie, surgical diversity) using 2 quarters of discharge abstracts from Texas. RESULTS: Of the 75,789 ICD-10-PCS codes from federal fiscal year 2017, 16,839 (22.3%) pairs differed only by laterality (with each pair contributing 2 codes). With the combining of equivalent codes, diversity in the state of Texas decreased from 78.2 to 74.1 operative procedures (95% confidence interval, 5.1 to −3.1; P

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In Response

No abstract available

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Agreement Analysis: What He Said, She Said Versus You Said

Correlation and agreement are 2 concepts that are widely applied in the medical literature and clinical practice to assess for the presence and strength of an association. However, because correlation and agreement are conceptually distinct, they require the use of different statistics. Agreement is a concept that is closely related to but fundamentally different from and often confused with correlation. The idea of agreement refers to the notion of reproducibility of clinical evaluations or biomedical measurements. The intraclass correlation coefficient is a commonly applied measure of agreement for continuous data. The intraclass correlation coefficient can be validly applied specifically to assess intrarater reliability and interrater reliability. As its name implies, the Lin concordance correlation coefficient is another measure of agreement or concordance. In undertaking a comparison of a new measurement technique with an established one, it is necessary to determine whether they agree sufficiently for the new to replace the old. Bland and Altman demonstrated that using a correlation coefficient is not appropriate for assessing the interchangeability of 2 such measurement methods. They in turn described an alternative approach, the since widely applied graphical Bland–Altman Plot, which is based on a simple estimation of the mean and standard deviation of differences between measurements by the 2 methods. In reading a medical journal article that includes the interpretation of diagnostic tests and application of diagnostic criteria, attention is conventionally focused on aspects like sensitivity, specificity, predictive values, and likelihood ratios. However, if the clinicians who interpret the test cannot agree on its interpretation and resulting typically dichotomous or binary diagnosis, the test results will be of little practical use. Such agreement between observers (interobserver agreement) about a dichotomous or binary variable is often reported as the kappa statistic. Assessing the interrater agreement between observers, in the case of ordinal variables and data, also has important biomedical applicability. Typically, this situation calls for use of the Cohen weighted kappa. Questionnaires, psychometric scales, and diagnostic tests are widespread and increasingly used by not only researchers but also clinicians in their daily practice. It is essential that these questionnaires, scales, and diagnostic tests have a high degree of agreement between observers. It is therefore vital that biomedical researchers and clinicians apply the appropriate statistical measures of agreement to assess the reproducibility and quality of these measurement instruments and decision-making processes. Accepted for publication February 20, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2018 International Anesthesia Research Society

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Reflections on Combining the Bonfils Intubation Endoscope, the Macintosh Videolaryngocope and the Difficult Airway

No abstract available

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Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Colorectal Surgery

The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery (ISCR), which is a national effort to disseminate best practices in perioperative care to more than 750 hospitals across multiple procedures in the next 5 years. The program will integrate evidence-based processes central to enhanced recovery and prevention of surgical site infection, venous thromboembolic events, catheter-associated urinary tract infections with socioadaptive interventions to improve surgical outcomes, patient experience, and perioperative safety culture. The objectives of this review are to evaluate the evidence supporting anesthesiology components of colorectal (CR) pathways and to develop an evidence-based CR protocol for implementation. Anesthesiology protocol components were identified through review of existing CR enhanced recovery pathways from several professional associations/societies and expert feedback. These guidelines/recommendations were supplemented by evidence made further literature searches. Anesthesiology protocol components were identified spanning the immediate preoperative, intraoperative, and postoperative phases of care. Components included carbohydrate loading, reduced fasting, multimodal preanesthesia medication, antibiotic prophylaxis, blood transfusion, intraoperative fluid management/goal-directed fluid therapy, normothermia, a standardized intraoperative anesthesia pathway, and standard postoperative multimodal analgesic regimens. Accepted for publication February 7, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Christopher L. Wu, MD, Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Hospital, Zayed 8-120J, 1800 Orleans St, Baltimore, MD 21287. Address e-mail to chwu@jhmi.edu. © 2018 International Anesthesia Research Society

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A Cadaveric Study of Ultrasound-Guided Maxillary Nerve Block Via the Pterygopalatine Fossa: A Novel Technique Using the Lateral Pterygoid Plate Approach

Background and Objectives This study aimed to describe and assess the accuracy and feasibility of a novel technique for ultrasound-guided maxillary nerve block using the lateral pterygoid plate (LPP) approach via the pterygopalatine fossa (PPF) in a soft cadaveric model. Methods Ten soft cadavers were studied. The curved array ultrasound transducer probe was applied over 1 side of the face of the cadavers in the open-mouth posture. It was placed transversely below the zygomatic arch for identifying the border of the maxillary tuberosity and the LPP. We tilted the curve probe from the caudal to the cranial direction until the uppermost part of the PPF was identified. The in-plane needle approach was used from the anterior-to-posterior and lateral-to-medial directions through the fossa, and 3 mL of methylene blue dye was injected. Results The spread of injectate after ultrasound-guided maxillary nerve block using the LPP approach was successfully performed in all cadavers as demonstrated by visualized moderate to marked traces of methylene blue within the PPF. No accidental injections in the maxillary arteries or facial nerves were observed. Conclusions This cadaveric study suggests that ultrasound-guided maxillary nerve block using the LPP approach via the PPF has a high degree of accuracy and feasibility. Further studies are required to confirm its efficacy and safety for clinical application. Accepted for publication January 15, 2018. Address correspondence to: Yasuyuki Shibata, MD, PhD, Department of Anesthesiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan (e-mail: yshiba@tuba.ocn.ne.jp; yshiba@med.nagoya-u.ac.jp). This study was supported by the Ratchadapiseksompotch, Faculty of Medicine, Chulalongkorn University, (grant RA59/075). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Kindlin-1 Regulates Astrocyte Activation and Pain Sensitivity in Rats With Neuropathic Pain

Background and Objectives Astrocyte activation has been implicated in the pathogenesis of neuropathic pain, but the involvement of kindlin-1 in astrocyte activation and neuropathic pain has not yet been illustrated. Using a chronic constriction injury (CCI) rat model of neuropathic pain, we investigated the expression levels of kindlin-1 during neuropathic pain and the influences of kindlin-1 on regulating pain sensitivity. Methods Neuropathic pain was induced in rats by CCI of the sciatic nerve. Rats were randomly assigned to 4 groups: sham operation, CCI, CCI + kindlin-1 short hairpin RNA (shRNA), and CCI + kindlin-1 groups. Animals in the CCI + kindling-1 shRNA and CCI + kindlin-1 groups were given kindlin-1 shRNA or kindlin-1 virus infection to reduce or overexpress kindlin-1, respectively. Kindlin-1 expression was persistently increased in rats 10 days after CCI. A large proportion of glial fibrillary acidic protein (GFAP)–positive astrocytes expressed kindlin-1 in spinal cord tissues of rats after CCI. Results Compared with the sham operation group, CCI animals exhibited increased GFAP expression and GFAP-positive astrocytes in the spinal cord. Down-regulation of kindlin-1 reduced the up-regulation of GFAP in the spinal cord, whereas overexpression of kindlin-1 promoted elevation of GFAP levels. Kindlin-1 silencing elevated the mechanical and thermal pain thresholds of CCI rats (P

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Reliability of tensiomyography and myotonometry in detecting mechanical and contractile characteristics of the lumbar erector spinae in healthy volunteers

Abstract

Purpose

Tensiomyography™ (TMG) and MyotonPRO^® (MMT) are two non-invasive devices for monitoring muscle contractile and mechanical characteristics. This study aimed to evaluate the test–retest reliability of TMG and MMT parameters for measuring (TMG:) muscle displacement (D_m), contraction time (T_c), and velocity (V_c) and (MMT:) frequency (F), stiffness (S), and decrement (D) of the erector spinae muscles (ES) in healthy adults. A particular focus was set on the establishment of reliability measures for the previously barely evaluated secondary TMG parameter V_c.

Methods

Twenty-four subjects (13 female and 11 male, mean ± SD, 38.0 ± 12.0 years) were measured using TMG and MMT over 2 consecutive days. Absolute and relative reliability was calculated by standard error of measurement (SEM, SEM%), Minimum detectable change (MDC, MDC%), coefficient of variation (CV%) and intraclass correlation coefficient (ICC, 3.1) with a 95% confidence interval (CI).

Results

The ICCs for all variables and test–retest intervals ranged from 0.75 to 0.99 indicating a good to excellent relative reliability for both TMG and MMT, demonstrating the lowest values for TMG T_c and between-day MMT D (ICC < 0.90). Absolute reliability was suitable for all parameters (CV 2–8%) except for D_m (10–12%). V_c demonstrated to be the most reliable and repeatable TMG parameter (ICC > 0.95, CV < 8%).

Conclusion

The reliability for TMG V_c could be established successfully. Its further applicability needs to be confirmed in future studies. MMT was found to be more reliable on repeated testing than the two other TMG parameters D_m and T_c.

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Psychopathology, everyday behaviors, and autonomic activity in daily life: An ambulatory impedance cardiography study of depression, anxiety, and hypomanic traits

Publication date: Available online 19 April 2018
Source:International Journal of Psychophysiology
Author(s): Sarah H. Sperry, Thomas R. Kwapil, Kari M. Eddington, Paul J. Silvia
Discrepancies regarding the link between autonomic nervous system (ANS) activity and psychopathology may be due in part to inconsistent measurement of non-psychological factors, including eating, drinking, activity, posture, and interacting with others. Rather than sources of noise, behaviors like being active and being with others may be the behavioral pathways that connect psychopathology symptoms to autonomic activity. The present study examined whether behaviors mediate the association of depression, anxiety, and hypomanic traits with ANS by using experience sampling methodology and ambulatory impedance cardiography. Participants (n = 49) completed measures of affect and one day of experience sampling and ambulatory impedance cardiography. The association of hypomanic traits with heart rate variability and heart rate was mediated by physical activity, and social activity mediated the association of depressive symptoms and respiration. These results highlight the importance of considering the pathways between psychopathology and ANS and the mediating role that everyday behaviors play.



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Successful performance and cardiovascular markers of challenge and threat: A meta-analysis

Publication date: Available online 19 April 2018
Source:International Journal of Psychophysiology
Author(s): Maciej Behnke, Lukasz D. Kaczmarek
Cardiovascular responses to challenge and threat have been used extensively in psychophysiological research. In this meta-analysis, we scrutinized the body of evidence for the role of challenge and threat hemodynamic responses in predicting positive behavioral outcomes, i.e., performance quality. We accounted for cardiac output (CO), total peripheral resistance (TPR), and Challenge-Threat Index (CTI). With 17 articles covering 19 studies (total N = 1045), we observed that the literature might have been biased towards positive results. After we excluded outlying studies and compensated for missing null-effect studies, we found that the mean standardized coefficient, corrected with the trim-and-fill method, was r = 0.14 for CO, r = −0.13 for TPR, and r = 0.10 for CTI. This indicated relatively small but stable effects of cardiovascular responses in the facilitation of successful performance. Moderator analyses indicated that TPR and CTI produced stronger effects in non-experimental studies. We also found that effects were not moderated by levels of engagement (indexed by heart rate and pre-ejection period), task domain (cognitive vs. behavioral) and measurement method. In summary, our results supported the general validity of the biopsychosocial model in the prediction of behavioral outcomes. However, they also indicated limitations of the empirical evidence and a significant bias in the literature.



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Neuromuscular and electromechanical properties of ultra-power athletes: the traceurs

Abstract

Purpose

Practising a power-type activity over years can shape the neuromuscular profile of athletes. This study aimed at comparing the neuromuscular profile of a non-trained group (NT, n = 10) to power athletes practising Parkour (= traceurs, group PK, n = 11), an activity consisting of jumping obstacles mostly in an urban landscape.

Methods

Maximal isometric plantar flexion force (MVC) and rate of torque development (RTD) were evaluated, and neuromuscular function of triceps surae muscles was assessed and compared between groups through the analysis of evoked potentials from posterior tibial nerve stimulation.

Results

PK group exhibited higher MVC force (131.3 ± 8.7 Nm) than NT (110.4 ± 9.6 Nm, P = 0.03) and higher RTD (489.1 ± 93 Nm/s) than NT (296.9 ± 81 Nm/s). At a nervous level, this greater performance was related to a greater voluntary activation level (PK: 96.8 ± 3.6%; NT: 91.5 ± 7.7%; P = 0.02) and soleus V-wave amplitude (P = 0.03), and a lower antagonist co-activation (P = 0.02) and rest soleus spinal excitability (PK H_max/M_max: 0.32 ± 0.13; NT: 0.58 ± 0.17; P < 0.001). At a muscular level, PK group exhibited higher mechanical twitch amplitude (PK: 13.42 ± 3.52 Nm; NT: 9.86 ± 4.38 Nm; P = 0.03) and electromechanical efficiency (P = 0.04).

Conclusions

The greater maximal force production capacity of traceurs compared to untrained was underlain by nervous factors, such as greater descending command and greater ability to modulate the spinal excitability, but also by muscular factors such as greater excitation–contraction coupling efficiency. The high eccentric loads that characterize Parkour training may have led traceurs to exhibit such neuromuscular profile.

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Opioids delay healing of spinal fusion: a rabbit posterolateral lumbar fusion model

Opioid use is prevalent for management of pre- and post-operative pain in patients undergoing spinal fusion. There is evidence that opioids downregulate osteoblasts in-vitro, and one previous study found that morphine delays the maturation and remodeling of callus in a rat femur fracture model. However, the effect of opioids on healing of spinal fusion has not been investigated before. Isolating the effect of opioid exposure in humans would be limited by the numerous confounding factors that affect fusion healing.

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SRS-schwab grade 4 osteotomy for congenital thoracolumbar kyphosis: a minimum of 2 years follow-up study

Several osteotomy techniques including pedicle subtraction osteotomy and vertebral column resection have been employed in the correction of congenital kyphosis (CK) and satisfying outcomes have been demonstrated. However, the SRS-Schwab Grade 4 osteotomy, defined as resection of posterior elements, partial vertebral body and superior adjacent disc, is rarely reported in the treatment of CK.

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Workplace spirituality and burnout

Workplace spirituality and burnout
Santosh Kumar Sharma; Ankita Sharma
International Journal of Behavioural and Healthcare Research, Vol. 6, No. 2 (2018) pp. 136 - 148
In the contemporary corporate and management world, the concept of 'spirituality at workplace' or popularly known as 'workplace spirituality' has received a global attention as a positive organisational phenomenon. The extant literature related to this concept indicates that there could be several consequences of infusing spirituality at workplace like organisational commitment, enhanced performance, increased productivity, managerial effectiveness, employee well-being, stress resiliency, and others. However, literature is silent on explaining the linkage of workplace spirituality with employee's burnout which is emerging as a vital organisational issue. This was the key motivation which energised us to empirically examine the role of workplace spirituality in handling burnout (excessive stressful situations) which is generally raised out of increasing complexities in our professional and personal life. We collected the data through questionnaire-based surveys in a sample of 132 employees working in service sector organisations across North India and carried out further statistical analyses with the help of SPSS software. The findings of the study divulge the fact that the concept of 'workplace spirituality' could be recognised as an important predictor of organisational outcomes which are affected by employee's burnout. Implications, limitations, further research directions, and conclusions have been discussed.

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Reduction of agitation and anxiety observed in a case study of people with dementia using TimeSlips™ creative expression program

Reduction of agitation and anxiety observed in a case study of people with dementia using TimeSlips™ creative expression program
Eileen L. Sullivan; George P. Sillup; Ronald K. Klimberg
International Journal of Behavioural and Healthcare Research, Vol. 6, No. 2 (2018) pp. 103 - 119
TimeSlips™ is a group storytelling program encouraging creative expression among people with dementia. A case study was conducted to evaluate whether TimeSlips could decrease symptoms of agitation and anxiety, in people with dementia, utilising the overt agitation severity scale (OASS). Participants included 42 residents diagnosed with dementia and impaired by anxiety and/or agitation. Despite a rigorous enrolment process, consent for only 15 residents was attained; 12, who routinely participated in TimeSlips and control sessions, which were conducted twice weekly for six weeks. OASS ratings were conducted before and after all sessions. When pre- and post-OASS ratings were compared for, all study participants showed clear reductions in agitation and anxiety as measured by changes in OASS scores (p < .001). The TimeSlips group was as effective as the control group and consistently had lower OASS scores, showing promise for care of persons with dementia, expressing symptoms of anxiety and agitation.

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An empirical investigation of pan, tobacco and intoxicants consumption at household level in India

An empirical investigation of pan, tobacco and intoxicants consumption at household level in India
Alok Kumar Pandey; Annapurna Dixit
International Journal of Behavioural and Healthcare Research, Vol. 6, No. 2 (2018) pp. 81 - 102
The present paper estimates the responsiveness of prices and household expenditure on consumption of three broad categories, i.e., pan, tobacco and intoxicants at household level in rural and urban areas of all India. Household level elasticities are estimated for the various deciles class (economic status) of families. The pattern shows that the rural household spending is proportionally more on pan than that of their urban counterparts. The expenditure on pan, tobacco and intoxicants at household level is inelastic. The marginal propensity to consume at household level for pan, tobacco and intoxicants is low in India. One rupee increase in the per capita expenditure will increase consumption of pan in rural region while for tobacco and intoxicants in urban region.

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Sound pollution: a source of social health inequality for people living near fixed and intermittent sources of pollution in Burkina Faso

Sound pollution: a source of social health inequality for people living near fixed and intermittent sources of pollution in Burkina Faso
Noel Thiombiano; Ibrahim Niankara
International Journal of Behavioural and Healthcare Research, Vol. 6, No. 2 (2018) pp. 120 - 135
This article relies on a Poisson modelling framework to examine the impact of constant and intermittent sound pollution on social health inequalities in Burkina Faso from the angle of hearing impairments. Using a random sample of 838 people in 200 household living nearby the international airport of Ouagadougou, and the National Electricity Company's (SONABEL) thermal power plants, the empirical results show that noise intensity is a significant determinant of hearing loss and a source of environmental inequity. In fact, constant exposure to high-intensity noise doubles the probability of developing hearing loss compared to temporary exposure. Consequently, to protect themselves, people tend to choose areas less exposed to noise but relatively more expensive, and hence supporting Charles Tiebout's theory of voting by the feet. The results also points out the problems of poor urban planning in developing countries, and suggest that prevention and promotion policies targeting the poorest are possible ways of reducing social health inequalities.

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An analysis of the mediating effect of emotional intelligence between self-evaluation traits with emotional and spiritual well-being

An analysis of the mediating effect of emotional intelligence between self-evaluation traits with emotional and spiritual well-being
S. Madhivanan; S. Riasudeen
International Journal of Behavioural and Healthcare Research, Vol. 6, No. 2 (2018) pp. 149 - 166
This study contributes to our understanding of the role performed by emotional intelligence in between self-evaluative traits and emotional well-being. We developed and tested a mediation model linking self-evaluative traits through emotional intelligence on predicting emotional and spiritual well-being. Drawing on our model posits that the effects of self-evaluative such as self-esteem, self-efficacy and locus of control are mediated by emotional intelligence on generating emotional and spiritual well-being. Overall data from 262 nurses from various government hospitals in Pondicherry Union territory support this model. This suggests that incorporation of emotional intelligence with self-evaluative traits on generating emotional and spiritual well-being is essential. Implication, directions of future research or discussed.

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