Firefighter fitness, movement qualities, occupational low-back loading demands and injury potential

BACKGROUND and OBJECTIVES: Low-back overexertion injuries represent a large proportion of fireground “strains, sprains and muscular pains” and are a leading cause of disability and early retirement in firefighters. Given the inherently hazardous and unpredictable nature of many fireground activities, it is often infeasible to implement “task-focused” ergonomic controls and there are limited options to accommodate injured firefighters. Accordingly, effective and practical “worker-focused” injury prevention approaches are needed. Toward this end, four studies were conducted to address the following global thesis objectives: 1) Examine the possible role that firefighters’ personal movement strategies could have on their occupational low-back loading demands and injury potential; and 2) Compare the effects of two different exercise approaches on firefighters’ occupational low-back loading demands and injury potential. STUDY 1: Low-Back Loading Demands during Simulated Firefighting Tasks – Inter-Subject Variation and the Impact of Fatigue and Gender. Background: Non-modifiable fireground duties are considered hazardous for low-back health, but personal movement strategies could modulate low-back loading demands and injury potential. Study objectives were to quantify low-back loading demands during simulated firefighting tasks and to examine the impact of fatigue and gender on the peak loading response. Methods: Ten men and 10 women performed a battery of laboratory-simulated firefighting tasks before and following repeated bouts of a fatiguing stair-climbing protocol. An EMG-assisted three-dimensional dynamic biomechanical model was used to compute peak L4/L5 joint forces during task performance. Results: Peak low-back loading demands varied considerably between subjects and tasks, but 70% of all loading variables examined were of greater magnitudes in male subjects and 40% of all loading variables were of lower magnitudes in both males and females after stair-climbing. Some inter-subject variation in low-back loading was attributed to body size differences, but between- and within-subject differences in movement strategies also contributed to low-back loading variability between subjects and over time. Conclusions: Results of this study suggest that characteristics of individuals, tasks performed, and physical fatigue may influence peak low-back loading demands and injury potential in firefighters. Despite considerable inter-subject variation in the internal low-back loading response to fixed external task and environmental constraints, opportunities to attenuate low-back loading demands through movement behaviour adaptations alone may be limited to only a subset of fireground activities. STUDY 2: Ankle Immobilization alters Lifting Kinematics and Kinetics – Occupational Low-Back Loading Demands and Potential for Injury. Background: Firefighters with lingering lower extremity functional impairments could be forced to move in ways that increase their potential for sustaining occupational low-back lifting injuries. The study objective was to examine the impact of unilateral ankle immobilization on lifting kinematics and kinetics. Methods: With and without their right ankle immobilized, 10 male volunteers performed laboratory-simulated occupational lifting tasks. Together with force platform data, three-dimensional kinematics of the lumbar spine, pelvis, and lower extremities were collected, and a three-dimensional dynamic biomechanical model was used to calculate peak low-back compression and shear loading demands. Results: In comparison to the unaffected conditions, ankle immobilization resulted in less knee (p-values between 0.0004 and 0.0697) and greater lumbar spine (p-values between 0.0006 and 0.3491) sagittal motion when lifting. Associated with this compensatory movement strategy were greater L4/L5 anterior/posterior reaction shear forces (p-values between 0.0009 and 0.2450). However, in a few cases where individual compensatory movement strategies differed from the “group” response (i.e., subjects increased their sagittal knee and hip motion on the affected side), peak L4/L5 joint compressive loads increased while the peak L4/L5 anterior-posterior shear did not change. Conclusions: Distal lower extremity joint dysfunction can alter the way in which individuals move and load their low-backs when lifting. The specific ways in which individuals compensate for personal movement constraints could alter the potential site and mechanism of occupational low-back injury. STUDY 3: FMS™ Scores and Occupational Low-Back Loading Demands – Whole-Body Movement Screening as an Ergonomic Tool? Background: Results of Study 1 suggested that a whole-body movement screen could be used to identify personal characteristics that constrain movement behaviour in ways that impact occupational low-back loading demands and injury potential. The purpose of this study was to examine if Functional Movement Screen™ (FMS) scores could be used to project the low-back loading response to lifting. Methods: Sagittally symmetric and asymmetric laboratory-based lifting tasks were performed by 15 firefighters who scored greater than 14 on the FMS (high-scorers) and 15 size-matched low-scorers (FMS < 14). A three-dimensional dynamic biomechanical model was used to calculate low-back loading demands, and lumbar spine posture was recorded when peak low-back compression was imposed. Results: Regardless of the task performed, there were no differences in peak L4/L5 joint compression (p ≥ 0.4157), anterior/posterior reaction shear (p ≥ 0.5645), or medial/lateral reaction shear (p ≥ 0.2581) loading demands between high- and low-scorers. At the instant when peak compression force was detected, lumbar spine deviation was not different between high- and low-scorers about the lateral bend (p ≥ 0.4215), axial twist (p ≥ 0.2734), or flexion/extension (p ≥ 0.1354) axes. Conclusions: Using the previously established musculoskeletal injury prediction threshold value of 14, the composite FMS score did not project the low-back loading response to lifting. Future attempts to modify or reinterpret FMS scoring are warranted given that several previous studies have revealed links between composite FMS scores and musculoskeletal complaints. STUDY 4: Movement- vs. Fitness-Centric Exercise – Firefighter Fitness, Whole-Body Movement Qualities, and Occupational Low-Back Loading Outcomes. Background: The impact of exercise on firefighter job performance and cardiorespiratory fitness has been studied extensively, but its effect on musculoskeletal loading remains less understood. The aim of this study was to compare various physical fitness, general movement quality, and low-back loading outcomes between groups of firefighters who completed fitness- or movement-centric exercise. Methods: Fifty-four firefighters participated and were assigned to a control (CON), fitness-centric exercise (FIT), or movement-centric exercise (MOV) group. Before and after 12 weeks of exercise, subjects performed a physical fitness test battery, the Functional Movement Screen™ (FMS), and laboratory-simulated firefighting tasks during which low-back loading demands were quantified. Results: FIT and MOV subjects exhibited statistically significant improvements in nearly all measures of physical fitness (i.e., body composition, cardiorespiratory capacity, muscular strength, power, endurance, and flexibility), but FMS scores and occupational low-back loading demands were not impacted in a consistent way across individuals. Conclusions: Improving physical fitness can enhance job performance and prevent cardiac events in firefighters, but it was not clear that 12 weeks of exercise would alter their occupational low-back loading demands. Given variability in individual responses, the short study duration, and limited number and nature of tasks examined, more research incorporating alternative biomechanical and statistical analyses is needed to better understand how individuals adapt to chronic exercise and what impact these adaptations have on occupational movement behaviours, low-back loading demands, and low-back loading capacity. SUMMARY and CONCLUSIONS: Results confirmed that fireground activities are potentially hazardous for low-back health, as simulated occupational low-back loading demands routinely exceeded recommended exposure limits in the studies performed. However, results also indicated that personal movement strategies – possibly influenced by body size, preference, gender, physical fatigue, or distal lower extremity joint dysfunction – could alter occupational low-back loading demands and injury potential. It could not be concluded that occupational low-back loading demands and injury potential would be consistently affected by short-term improvements in physical fitness, nor could the low-back loading response to lifting be projected by scoring above or below 14 on the Functional Movement Screen™. Future research is warranted to examine the low-back loading demands associated with performing non-fireground duties, as opportunities may exist to implement ergonomic strategies to control cumulative low-back loading exposures. Particular attention should be paid to the exercise and training practices of firefighters, as musculoskeletal injuries sustained during these activities are potentially avoidable and could reduce the capacity of the musculoskeletal system to withstand demands imposed during non-modifiable fireground operations

Supranutritional supplementation of vitamin E influences mitochondrial proteome profile of post-mortem longissimus lumborum from feedlot heifers

Supplementation of vitamin E improves beef colour stability by minimizing lipid oxidation-induced myoglobin oxidation. Mitochondria affect myoglobin redox stability, and dietary vitamin E influences mitochondrial functionality in skeletal muscles. Nonetheless, the influence of vitamin E on the mitochondrial proteome of beef skeletal muscles has yet to be  investigated. Therefore, the objective of this study was to examine the effect of dietary vitamin E on mitochondrial proteome of post-mortem beef longissimus lumborum (LL) muscle. Beef LL muscle samples (24 hours post-mortem) were obtained from the carcasses of nine (n = 9) vitamin E-fed (VITE) (1000 IU vitamin E for 89 days) and nine (n = 9) control (CONT) (diet without supplemental vitamin E) heifers. The mitochondrial proteome was analysed using two-dimensional gel electrophoresis and mass spectrometry, and nine differentially abundant spots were identified. All the differentially abundant spots were over-abundant in CONT, and the proteins were electron transport chain enzymes (NADH dehydrogenase iron-sulphur protein 8, NADH dehydrogenase flavoprotein 2, and cytochrome c oxidase subunit 5B), metabolic enzymes (succinate-CoA ligase (ADP-forming) subunit beta; dihydrolipoyllysine-residue succinyltransferase component of 2-oxoglutarate dehydrogenase complex; pyruvate dehydrogenase protein X component), and enzymes involved in ATP regeneration (creatine kinase S-type). The low abundance of these proteins in VITE may decrease mitochondrial activity, resulting in low oxidative activity. These findings suggest that the strong antioxidant activity of vitamin E leads to less expression of mitochondrial oxidative enzymes in beef skeletal muscles.Keywords: Beef colour, lipid oxidation, mitochondrial enzyme

Ractopamine-induced changes in the proteome of post-mortem beef longissimus lumborum muscle

Ractopamine is a beta-adrenergic agonist that is approved for use in beef cattle, pigs and turkeys as a repartitioning agent to increase lean muscle deposition and decrease lipogenesis. Although the effects of dietary ractopamine on the proteome profile of post-mortem pork muscles have been examined, its influence on beef muscle proteome has not been studied. Therefore, the objective of this study was to examine the effect of ractopamine on the proteome profile of post-mortem beef longissimus lumborum (LL) muscle. LL muscle samples were obtained from the carcasses of six (n = 6) steers fed ractopamine (RAC; 400 mg ractopamine hydrochloride for 28 days) and six (n = 6) steers fed no ractopamine (CON). The muscle proteome was analysed using two-dimensional gel electrophoresis and tandem mass spectrometry. Five differentially abundant spots were identified, and all the spots were over-abundant in RAC. The identified proteins were involved in muscle structure development (F-actin-capping protein subunit beta-2; PDZ and LIM domain protein-3), chaperone activity (heat shock protein beta-1), oxygen transport (myoglobin), and glycolysis (L-lactate dehydrogenase A chain). These results suggested that dietary ractopamine could influence the abundance of enzymes associated with muscle development and muscle fibre type shift in beef LL muscle.Keywords: growth promotants, meat quality, proteomic

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Analysis of shared heritability in common disorders of the brain

Paroxysmal Cerebral Disorder

Distribution and concentration of trace and major elements in biological specimens using proton induced x-ray emission analysis and photon transmission tomography

SIGLEAvailable from British Library Document Supply Centre- DSC:DX181800 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Factor structure, stability, and congruence in the functional movement screen

© 2017 Taylor & Francis. The scoring scheme for the functional movement screen implicitly assumes that the factor structure is consistent, stable, and congruent across different populations. To determine if this is the case, we compared principal components analyses of three samples: a healthy, general population (n = 100), a group of varsity athletes (n = 101), and a group of firefighters (n = 397). The congruence of the principal components derived through these analyses were evaluated across all of the samples, using Tucker’s congruence coefficient. Factor extraction was guided by parallel analyses, and interpretation was facilitated by Varimax rotation. We observed factor instability, low factor congruence, and inconsistent factor structure. Additionally, we observed a two-factor structure of the functional movement screen in all of our sample groups. These analyses suggest that, although the independent elements of the functional movement screen may continue to be used, use of the composite score is not supported by the factor structure of the measure