Variation in occupational exposure associated with musculoskeletal complaints:a cross-sectional study among professional bassists

Variation in occupational exposure is assumed to have a protective effect against the development of musculoskeletal complaints (MSC), but this common assumption is not strongly supported by the literature. Among musicians, who have a high prevalence of MSC, many play more than one type of instrument (multi-instrumentalism) for many hours a day. Since multi-instrumentalism implies greater variation in ergonomic load of specific musculoskeletal areas than mono-instrumentalism, musicians are a suitable study population to test whether the above assumption is true. To investigate in a sample of professional bass players whether multi-instrumentalists are less likely to have MSC than mono-instrumentalists. Participants were 141 professional and professional student double bassists and bass guitarists. Demographic, MSC and exposure characteristics were collected online with self-constructed and existing questionnaires. Logistic regression analysis was used to test the association between multi- versus mono-instrumentalism and MSC, adjusted for confounders. The prevalence of having MSC in the neck, back, right shoulder area and both wrist areas did not differ significantly between the two groups. Further analysis revealed that the likelihood of having MSC in the left shoulder area was higher in multi-instrumentalists compared to mono-instrumentalists (Odds ratio 0.30, 95% CI 0.119-0.753, p = 0.010). In this sample of professional bass players, no protective effect of multi-instrumentalism against MSC was found. Multi-instrumentalism was associated with a higher prevalence of MSC in the left shoulder. This result challenges theoretical and clinical assumptions in occupational and pain medicine

Contemporary outcomes of continuous-flow biventricular assist devices.

BACKGROUND: Significant right ventricular failure (RVF) complicating left ventricular assist device (LVAD) placement has been reported at 10–30%. Although primarily indicated for left ventricular failure, ventricular assist devices (VADs) have become utilized in a biventricular setup to combat right ventricular failure (RVF) following LVAD implantation. With the advent of continuous-flow LVADs (CF-LVADs) superseding their pulsatile predecessors, the shift towards CF-biventricular assist devices (CF-BiVADs) come with the prospect of improved outcomes over previous pulsatile BiVADs. We aim to review the literature and determine the outcomes of CF-BiVAD recipients. METHODS: A systematic review was performed to determine the outcomes of CF-BiVADs. Pre-operative demographics and device configuration data was collected. Primary outcomes evaluated were short-term survival, long-term survival, duration of support, and survival to transplant. Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (ICU-LOS and HLOS, respectively), pump thrombosis, pump exchange. Median and interquartile range was reported where appropriate. A major limitation was the likely overlap of cohorts across publications, which may have contributed to some selection bias. RESULTS: Of 1,282 screened, 12 publications were evaluated. Sample size ranged from 4 to 93 CF-BiVAD recipients, and follow-up ranged from 6 to 24 months. Mean age ranged from 34 to 52 years old. Forty-five percent of CF-BiVADs had right atrial (RA-) inflow cannulation, with the remaining being right ventricular (RV). Thirty-day survival was a median of 90% (IQR 82–97.8%) and 12-month survival was a median of 58.5% (IQR 47.5–62%). Where reported, rate of pump thrombosis (predominantly the right VAD) was a median of 31% (IQR 14–36%), although pump exchange was only 9% (IQR 1.5–12.5%). CONCLUSIONS: RVF post-LVAD implantation is a high morbidity and mortality complication. There is no on-label continuous-flow RVAD currently available. Thus, the modifications of LVADs for right ventricular support to combat pump thrombosis has resulted in various techniques. BiVAD recipients are predominantly transplant candidates, and complications of pump thrombosis and driveline infection whilst on wait-list are of great consequence. This study demonstrates the need for an on-label CF-BiVAD

Quality and usability of clinical assessments of static standing and sitting posture:A systematic review

BACKGROUND: A validated method to assess sitting and standing posture in a clinical setting is needed to guide diagnosis, treatment and evaluation of these postures. At present, no systematic overview of assessment methods, their clinimetric properties, and usability is available. OBJECTIVE: The objective of this study was to provide such an overview and to interpret the results for clinical practice. METHODS: A systematic literature review was performed according to international guidelines. Two independent reviewers assessed risk of bias, clinimetric values of the assessment methods, and their usability. Quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE). RESULTS: Out of 27,680 records, 41 eligible studies were included. Thirty-two assessment instruments were identified, clustered into five categories. The methodological quality of 27 (66%) of the articles was moderate to good. Reliability was most frequently studied. Little information was found about validity and none about responsiveness. CONCLUSIONS: Based on a moderate level of evidence, a tentative recommendation can be made to use a direct visual observation method with global posture recorded by a trained observer applying a rating scale

Taking It to the Extreme:The Effect of Coalition Cabinets on Foreign Policy

Institutional constraints have been offered by some scholars as an explanation for why multiparty coalitions should be more peaceful than single-party cabinets. Yet others see the same institutional setting as a prescription for more aggressive behavior. Recent research has investigated these conflicting expectations, but with mixed results. We examine the theoretical bases for these alternative expectations about the effects of coalition politics on foreign policy. We find that previous research is limited theoretically by confounding institutional effects with policy positions, and empirically by analyzing only international conflict data. We address these limitations by examining cases of foreign policy behavior using the World Event/Interaction Survey (WEIS) dataset. Consistent with our observation that institutional constraints have been confounded with policy positions, we find that coalitions are neither more aggressive nor more peaceful, but do engage in more extreme foreign policy behaviors. These findings are discussed with regard to various perspectives on the role of institutions in shaping foreign policy behavior.</p

Marine spatial planning: risk or opportunity for fisheries in the North Sea?

The North Sea is one of the busiest marine areas in the world. It is also a major fisheries ground. Bordered by seven countries with their own spatial uses and claims, the stage is set for complex and demanding governance challenges. Recent decades have also seen user groups multiply, competition for space and resources increase, and the pressure on the marine environment and its living natural resources grow. As governments strive to balance conservation and economic development needs, they also have to deal with inter-as well as intra-national user conflicts. Marine Spatial Planning (MSP) has arrived as a new approach to these issues. It is argued that for North Sea fishing people and their communities MSP holds risks as well as opportunities, depending on which institutions are formed and what role they are allowed to play in the planning process