EMG Analysis of Neural Activation Patterns of the Gluteal Muscle Complex

Gluteal amnesia is described as a condition in which the neural recruitment patterns of the gluteal muscle complex are insufficient to activate muscle fibers, causing the hamstring and lower back muscles to take up the physical demand. Symptoms due to insufficient gluteal muscle activation include tight hamstrings post-exercise, anterior pelvic tilt, and knee valgus during squat or lunge performance. This could lead to compensation injuries of the lumbar, knee, and ankle joints. Many physical therapy rehabilitation programs of the lower back and lower extremity incorporate gluteal exercises which could potentially treat this condition and prevent compensation injuries. PURPOSE: To identify and test a person experiencing symptoms of gluteal amnesia to determine gluteal muscle activation before and after a therapy program designed to enhance muscle recruitment and function. METHODS: A 74-year-old male experiencing symptoms of unilateral gluteal amnesia was recruited for this case-study. Electromyographic (EMG) analysis of the gluteal muscle complex was recorded while the subject performed movements typically associated with gluteal muscle complex activation. Both the affected and unaffected side were analyzed while the subject performed movements, as well as submaximal and maximal voluntary isometric contractions (MVIC). After baseline testing, a daily, 3-week progressive resistance rehabilitation program consisting of exercises utilizing the gluteal muscle complex was completed. After completion of the rehabilitation program, EMG analysis of the affected and unaffected sides was performed as during the baseline measures. Integrated EMG signals of gluteal activation were compared between pre- and post-tests. Baseline EMG was considered to be 100% of muscle activation. The post-rehabilitation EMG during MVIC was a percentage of the maximal effort output. MVIC of the submaximal tests were obtained by comparing the quadruped hip extension and single leg glute bridge exercises to the standing gluteal squeeze, and the quadruped hip abduction and clam shell exercises to the side lying hip abduction. RESULTS: Increased gluteal complex activation post-rehabilitation was evident in both the affected and unaffected limbs. Specifically, the largest increases of the left and ride side were seen through the quadruped hip extension (18.7%, 52.4%) and quadruped hip abduction (54.1%, 98.8%) exercises, respectively. The left limb presenting with gluteal amnesia symptoms consistently gave lower output values. CONCLUSION: In this case-study, increased EMG activity in the affected muscles, progressive increases in resistance during daily rehabilitation and anecdotal improvements in movement patterns were observed. Based on the results of this case-study, treatment for conditions such as gluteal amnesia and other disorders of ineffective motor unit recruitment should include targeted rehabilitation exercises designed to isolate the affected musculature

The Political Economy of Failure: The Euro as an International Currency

How do international currencies get established and consolidated? What domestic and international political foundations support an international currency? And what kinds of macro-economic flows enable an international currency? In this essay we consider these perennial questions of modern IPE scholarship in reverse order to ask whether the euro could ever have become, or seek to become, a true international currency rivalling the US dollar, used not only for passive foreign exchange reserves but also as a major commercial currency outside the EU. We argue that the EU lacks the will, the ideas and the capacity to promote the euro into the status of an international currency. In this article, we concentrate on this final issue of capacity, as the will and ideas issues have already been well explored. Capacity is an issue coeval with, if not prior to, the first two issues. The EU's current institutional arrangements and its economic geography create macro-economic consequences that diminish the euro's capacity to operate as a top currency. These conflicts go beyond the well-recognized issue that the euro-zone is not an optimum currency area. Examining the euro's debilities sheds light not only on the euro's (in)capacity to rival the dollar as an international currency, but also on the future of both the euro and the dollar in the aftermath of the euro-zone crisis

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage. By retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient's condition on-scene and hospital course. Average age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of a,not sign 34,448, amounting to 2.2% of the total MMT costs during the study period. In our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable level

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Why California retailers stop selling tobacco products, and what their customers and employees think about it when they do: case studies

BACKGROUND: In California, some 40, 000 retailers sell tobacco products. Tobacco's ubiquitousness in retail settings normalizes use and cues smoking urges among former smokers and those attempting cessation. Thus, limiting the number of retailers is regarded as key to ending the tobacco epidemic. In the past decade, independent pharmacies and local grocery chains in California and elsewhere have voluntarily abandoned tobacco sales. No previous studies have examined the reasons for this emerging phenomenon. We sought to learn what motivated retailers to discontinue tobacco sales and what employees and customers thought about their decision. METHODS: We conducted case studies of seven California retailers (three grocery stores, four pharmacies) that had voluntarily ceased tobacco sales within the past 7 years. We interviewed owners, managers, and employees, conducted consumer focus groups, unobtrusively observed businesses and the surrounding environment, and examined any media coverage of each retailer's decision. We analyzed data using qualitative content analysis. RESULTS: For independent pharmacies, the only reason given for the decision to end tobacco sales was that tobacco caused disease and death. Grocers listed health among several factors, including regulatory pressures and wanting to be seen as "making a difference." Media coverage of stores' new policies was limited, and only three retailers alerted customers. Management reported few or no customer complaints and supportive or indifferent employees. Pharmacy employees were pleased to no longer be selling a deadly product. Grocery store management saw the decision to end tobacco sales as enhancing the stores' image and consistent with their inventory of healthy foods. Focus group participants (smokers and nonsmokers) were largely unaware that retailers had stopped selling tobacco; however, almost all supported the decision, viewing it as promoting public health. Many said knowing this made them more likely to shop at the store. Most thought that advertising the store's policy was essential to generate good public relations and tobacco norm changes. CONCLUSIONS: Voluntary retailer abandonment of tobacco sales both reflects and extends social norm changes that have problematized tobacco in California. Our findings suggest that such voluntary initiatives by retailers are welcomed by consumers and should be publicized, enhancing public health efforts