Grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities?

<p>Abstract</p> <p>Background</p> <p>In a majority of cases, whiplash injuries are a domain of conservative therapy. Nevertheless it remains unclear whether physical therapy is of medical or economic benefit in patients with whiplash injuries.</p> <p>Methods</p> <p>Seventy patients with acute Quebec Task Force (QTF) grade II whiplash injuries were randomized to two therapy groups and received either active (APT) or passive (PPT) physical therapy. Patients were compared with regard to pain and range of motion with data obtained in an earlier study from a group with grade II whiplash injuries in which the therapy recommendation had been "act as usual" (AAU; n = 20). The above-mentioned parameters were assessed at 24 hours and two months after the injury. Furthermore patients' period of disability was documented after two months.</p> <p>Results</p> <p>After two months, patients in both the APT and PPT groups showed significant improvement in the median period of disability (active: 14 days; passive: 14 days) compared to the AAU group (49 days). No group difference was observed with regard to median improvement in range of motion (active: 120°; passive: 108°; activity as usual: 70°). The median pain reduction was significantly greater in the APT group (50.5) than in the PPT (39.2) or AAU group (28.8).</p> <p>Conclusion</p> <p>Our data show that active physical therapy results in enhanced pain reduction and shortening of post-injury disability. Therefore, active physical therapy should be considered the treatment of choice in patients with QTF grade II whiplash injuries.</p> <p>Trial registration</p> <p>The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.</p

Active school transport and fast food intake: are there racial and ethnic differences?

Objectives To investigate whether active school transport was associated with fast food consumption, and to examine differences across racial/ethnic groups. Methods Adolescent data (n = 3194) from the 2009 California Health Interview Survey were analyzed with logistic regression models to examine the association between active school transport (AST) and fast food intake across racial/ethnic groups. Results In the overall sample, AST during 1–2 days in the past week was associated with greater likelihood of fast food intake (OR: 1.58; 95% CI: 1.03–2.43), compared with zero days of AST, controlling for demographic and other factors. The association between AST and fast food intake differed significantly by race/ethnicity (p < 0.01). Among Latino adolescents, greater frequency of AST was significantly associated with greater likelihood of fast food intake (1–2 days OR, 2.37, 95%CI: 1.05–5.35; 3–4 days OR, 2.78, 95% CI: 1.04–7.43; 5 days OR, 2.20, 95%CI: 1.23–3.93). Among White and Asian adolescents, there was a curvilinear pattern: relative to adolescents who reported zero days of AST, those who did AST 1–2 days/week had greater likelihood of fast food intake, but AST of 3–4 days and 5 days/week was associated respectively, with higher and lower likelihood of fast food intake among both groups. Conclusions AST appears to be a risk factor for fast food intake, and may expose some ethnic groups more than others to increased opportunity to purchase and consume fast food. Programs and policies to promote AST among adolescents should incorporate efforts to encourage healthy eating and discourage concentration of fast food outlets near schools

Deceleration during 'real life' motor vehicle collisions – a sensitive predictor for the risk of sustaining a cervical spine injury?

<p>Abstract</p> <p>Background</p> <p>The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (ΔV) for the resulting cervical spine injuries were investigated in 57 cases after real-life car accidents.</p> <p>Methods</p> <p>ΔV was determined for every car and clinical findings related to the cervical spine were assessed and classified according to the Quebec Task Force (QTF).</p> <p>Results</p> <p>In our study, 32 (56%) subjects did not complain about symptoms and were therefore classified as QTF grade 0; 25 (44%) patients complained of neck pain: 8 (14%) were classified as QTF grade I, 6 (10%) as QTF grade II, and 11 (19%) as QTF grade IV. Only a slight correlation (r = 0.55) was found between the reported pain and ΔV. No relevant correlation was found between ΔV and the neck disability index (r = 0.46) and between ΔV and the QTF grade (r = 0.45) for any of the collision types. There was no ΔV threshold associated with acceptable sensitivity and specificity for the prognosis of a cervical spine injury.</p> <p>Conclusion</p> <p>The results of this study indicate that ΔV is not a conclusive predictor for cervical spine injury in real-life motor vehicle accidents. This is of importance for surgeons involved in medicolegal expertise jobs as well as patients who suffer from whiplash-associated disorders (WADs) after motor vehicle accidents.</p> <p>Trial registration</p> <p>The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.</p

Obesity prevention and personal responsibility: the case of front-of-pack food labelling in Australia

<p>Abstract</p> <p>Background</p> <p>In Australia, the food industry and public health groups are locked in serious struggle for regulatory influence over the terms of front-of-pack food labelling. Clear, unambiguous labelling of the nutritional content of pre-packaged foods and of standardized food items sold in chain restaurants is consistent with the prevailing philosophy of 'personal responsibility'. An interpretive, front-of-pack labelling scheme has the capacity to encourage healthier patterns of eating, and to be a catalyst for improvements in the nutritional quality of food products through re-formulation. On the other hand, the strength of opposition of the Australian Food and Grocery Council to 'Traffic Light Labelling', and its efforts to promote a non-interpretive, voluntary scheme, invite the interpretation that the food industry is resistant to any reforms that could destabilise current (unhealthy) purchasing patterns and the revenues they represent.</p> <p>Discussion</p> <p>This article argues that although policies that aim to educate consumers about the nutritional content of food are welcome, they are only one part of a broader basket of policies that are needed to make progress on obesity prevention and public health nutrition. However, to the extent that food labelling has the capacity to inform and empower consumers to make healthier choices - and to be a catalyst for improving the nutritional quality of commercial recipes - it has an important role to play. Furthermore, given the dietary impact of meals eaten in fast food and franchise restaurants, interpretive labelling requirements should not be restricted to pre-packaged foods.</p> <p>Summary</p> <p>Food industry resistance to an interpretive food labelling scheme is an important test for government, and a case study of how self-interest prompts industry to promote weaker, voluntary schemes that pre-empt and undermine progressive public health regulation.</p

Patient-centered insights: using health care complaints to reveal hot spots and blind spots in quality and safety

Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low‐level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient‐centered insights that localize issues and shed light on difficult‐to‐monitor problems. Context The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data. Methods We analyzed 1,110 health care complaints from across England. “Hot spots” were identified by mapping reported harm and near misses onto stages of care and underlying problems. “Blind spots” concerning difficult‐to‐monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission. Findings The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty‐three percent of problems entailed major or catastrophic harm, with significant regional variation (17%‐31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low‐level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns. Conclusions The analysis of health care complaints reveals valuable and uniquely patient‐centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry‐exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files

Kollisionsdynamik der beteilitgten Fahrzeuge als Kausalitätskriterium für Beschleunigungsverletzungen der Halswirbelsäule

Bislang wurde die Aussagekraft von Delta v für Halswirbelsäulenverletzungen nach Schleudertrauma bei Schlitten- und Crashtests Studien untersucht. Daten von realen Unfällen liegen bislang kaum vor. Diese Studie untersucht den Zusammenhang zwischen Delta v und Halswirbelsäulenverletzungen bei 57 Fällen nach realen PKW-Kollisionen. In allen Fällen wurden klinische Daten und das Delta v bestimmt. In 25 Fällen wurden Halswirbelsäulenverletzungen bei Delta v zwischen 9 km/h und 59km/h beobachtet. Die Delta v Werte der 32 Personen ohne Halswirbelsäulenverletzung betrugen zwischen 3 km/h und 37 km/h. Heckkollisionen mit Delta v = 9 km/h führten zu zwei QTF I Verletzungen, wurden bei Delta v = 37km/h jedoch auch ohne Beschwerden überstanden. Nach einer Frontalkollision wurden bei Delta v = 15 km/h eine Luxationsfraktur C5/6 beobachtet und andererseits Frontalkollisionen mit Delta v = 28 km/h ohne Beschwerden überstanden. Bei einer schiefwinkligen Kollision mit Delta v = 9 km/h wurde eine Luxationsfraktur C4/5 diagnostiziert, es wurden aber auch Delta v Werte von = 36 km/h unbeschadet überstanden. Ein Zusammenhang zwischen Delta v und der QTF Klassifikation oder der primären Schmerzintensität konnte nicht beobachtet werden. Die Ergebnisse dieser Studie zeigen, dass lediglich in Kenntnis des Delta v eine Aussage über das Risiko einer HWS Verletzung bei realen Unfällen nur sehr bedingt getroffen werden kann

A review on current status of capacity control techniques for two-phase ejectors

The adoption of highly efficient vapour-compression refrigeration, air conditioning and heat pump (RACHP) systems is compulsory to achieve a low-carbon society. Expansion work recovery using a two-phase ejector is widely recognized as one of the most promising measures to improve the energy efficiency of RACHP units. This holds true for all operation conditions provided that an effective capacity control technique is implemented. In this work a thorough critical review on the current status of the presently available capacity control techniques for two-phase ejectors was carried out. In addition, their pros and cons as well as the comparison of their performance were reported. It was concluded that two-phase ejectors can be properly capacity controlled in large- and medium-scale vapour-compression units. However, a suitable capacity control mechanism for small-scale vapour-compression solutions still requires a major breakthrough and is being intensively discussed among experts in the field.https://doi.org/10.1016/j.ijrefrig.2020.07.01

A review on current status of capacity control techniques for two-phase ejectors

The adoption of highly efficient vapour-compression refrigeration, air conditioning and heat pump (RACHP) systems is compulsory to achieve a low-carbon society. Expansion work recovery using a two-phase ejector is widely recognized as one of the most promising measures to improve the energy efficiency of RACHP units. This holds true for all operation conditions provided that an effective capacity control technique is implemented. In this work a thorough critical review on the current status of the presently available capacity control techniques for two-phase ejectors was carried out. In addition, their pros and cons as well as the comparison of their performance were reported. It was concluded that two-phase ejectors can be properly capacity controlled in large- and medium-scale vapour-compression units. However, a suitable capacity control mechanism for small-scale vapour-compression solutions still requires a major breakthrough and is being intensively discussed among experts in the field.https://doi.org/10.1016/j.ijrefrig.2020.07.01