The development of an index for the proximal upper extremity

Analysis techniques specific to the proximal upper extremity have historically been overlooked in the field of ergonomics. This research effort provides a methodology that will allow the ergonomics practitioner to analyze a job and predict whether or not that job exposes workers to increased risk of proximal upper extremity disorders. Literature from the fields of physiology, biomechanics, and epidemiology was assimilated in order to understand the theories of pathogenesis of disorders in the rotator cuff and to identify the risk factors associated with proximal upper extremity disorders. A retrospective epidemiological study was conducted to identify job task variables that may contribute to the occurrence of proximal upper extremity disorders. Two proximal upper extremity constructs were proposed: a fatigue-based model and a compressive load-based model. The constructs incorporated lessons learned from the literature and results from the epidemiological study. Validation of the models was performed using data from the epidemiological study. It was determined that the fatigue-based model was a good predictor of proximal upper extremity disorders

Earlier Application of Percutaneous Cardiopulmonary Support Rescues Patients from Severe Cardiopulmonary Failure Using the APACHE III Scoring System

Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score ≥50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores ≥50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival

Percutaneous Cardiopulmonary Support in Refractory No-Reflow with Cardiogenic Shock after Coronary Stenting in Acute Myocardial Infarction

Coronary no-reflow is defined as inadequate myocardial perfusion of a given coronary segment without angiographic evidence of mechanical vessel obstruction. No-reflow is visualized angiographically as a reduction in thrombolysis in myocardial infarction (TIMI) flow grade and is typically accompanied by chest pain, electrocardiographic changes with ST-segment shift and possible hemodynamic compromise. No-reflow during primary percutaneous coronary intervention (PCI) results in increasing mortality and morbidity. Therefore, treatment of noreflow is associated with improved clinical outcomes. Generally, the treatment of no-reflow is based on pharmacotherapy. In this case, despite maximal pharmacotherapy and intraaortic balloon pump (IABP), refractory no-reflow accompanied with cardiogenic shock was successfully treated with percutaneous cardiopulmonary support (PCPS)

Anesthetic management of a patient with a double inferior vena cava and pulmonary alveolar proteinosis who underwent bilateral living-donor lobar lung transplantation.

A 43-year-old woman with pulmonary fibrosis secondary to pulmonary alveolar proteinosis was scheduled to undergo lung transplantation. Before the lung transplantation, she had undergone multiple whole-lung lavage procedures on extracorporeal circulation (ECC), which had caused scarring of the right femoral subcutaneous tissues. Preoperative examination revealed a double inferior vena cava (IVC) with interiliac communication, and the left IVC ended at the left renal vein. Surgical exposure of the right femoral vessels was performed immediately after anesthetic induction for emergent vascular access to establish an ECC. Cardiopulmonary collapse did not occur and the ECC was not required until lung resection. The lung transplantation was completed uneventfully. Congenital IVC anomaly is rare, but may make cannulation through the femoral vein difficult. Scarring of the subcutaneous tissue could result in a difficult "percutaneous" approach to the vessels. Evaluation of the vascular anatomy related to the establishment of an ECC is important before lung transplantation

A comparison of workstation dimensions and body postures between 17" CRT, 21" CRT, and 19" flat panel monitors

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Includes bibliographical references (leaves 48-53).Issued also on microfiche from Lange Micrographics.Use of visual display terminals has been implicated as a risk factor in visual discomfort. With the progression of new technology, larger CRT monitors and alternate display technologies, such as flat panels, are entering the office environment. Few studies have evaluated the impact of these newer, larger monitors on important factors such as visual issues, user posture, user preferences, and productivity. This study attempts to investigate the effects of monitor size, viewing angle and viewing distance on posture, blink rate, productivity, user preference, and monitor readability. Three monitor sizes were studied: 17" CRT, 21" CRT, and 19" FP. Three viewing angles were evaluated: 0°, 10°, and 20°. Two viewing distances were studied: 30" and 37". Seventeen subjects performed two tasks (keyboarding and mousing) in each combination of monitor size, viewing angle, and viewing distance. Part of the experiment included allowing subjects to adjust their workstation and perform the tasks in the adjusted position. As viewing angle increased, the rate of blinking significantly increased. The monitors received significantly better readability ratings at the 30" viewing distance. Users preferred the 30" viewing distance with all monitors. Subjects were most productive in both the keyboarding and mousing tasks at the 20° viewing angle and the 30" viewing distance. When subjects were allowed to adjust their workstations, a viewing angle of approximately 20° and a viewing distance of a little over 30" was chosen for both the 19" FP and the 21" CRT

What’s new?

“What’s new?” is a provocative question and inherently linked to the invaluable retrospection, “What’s old?”, or, at least, should prompt a thorough reflection on where things were before acquiring the latest information on a given topic. Extracorporeal membrane oxygenation (ECMO) and the newer extracorporeal life support (ECLS) have revolutionized acute and critical care in just a few decades. As everyone knows, these applications depend heavily on the use of technology in concert with state-of-the-art medical management for critically ill patients. This issue of the journal has several excellent papers on the latest information for clinicians and researchers involved in ECLS. Many of these reports are derived from past EuroELSO congresses, with six papers from the one held in London in 2022 and three others from Lisbon in 2023. As a bonus, if such a word can be used in a scientific journal, there is an in-depth analysis on the complex interplay of the native respiratory system and a veno-venous extracorporeal circuit