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BACKGROUND: The function of trunk muscles in chronic nonspecific low back pain (CNLBP) is controversially discussed, and trunk muscle function in sedentary occupation workers is poorly understood. OBJECTIVE: To investigate whether muscle function differs between sedentary occupation workers with and without CNLBP and to determine the association between functional limitations and muscle function. METHODS: This study included 32 sedentary occupation workers (16 workers with CNLBP and 16 age- and sex-matched workers without CNLBP). Group differences in isokinetic trunk flexion-extension strength, muscle cocontraction, endurance time (Biering-Sorensen test) and electromyographic muscle fatigue were assessed. The association of these parameters and Oswestry Disability Index (ODI) score were examined in the CNLBP group. RESULTS: Participants with CNLBP had lower trunk extensor (- 20%) and flexor (- 18%) strength and less cocontraction (- 22%) than participants without CNLBP, but due to large variability in both groups these differences were not statistically significant. Trunk muscle endurance and fatigue were comparable between groups. Variance in endurance time explained 28% of variance in the ODI-score in the CNLBP group (R 2 = 0.277). CONCLUSIONS: In patients with CNLBP, greater functional disability was associated with lower endurance. Further evidence is necessary to elucidate whether specifically training endurance performance may be beneficial for sedentary occupation workers. [ABSTRACT FROM AUTHOR]

Expectations of association members change over time depending on two factors: age and length of membership. In the product- and service-marketing literature, the fact of changing needs and expectations during a customer’s life cycle is already well explored. So far, this is not the case in the research on members of nonprofit organizations. This paper closes this research gap from a member-value perspective by discussing the links among age, length of membership, and value perception. Survey data from 1,613 members of a Swiss hiking trail association reveal that both temporal metrics show significant positive relationships with all member-value dimensions: enjoyment, affection, identity, power, participation, understanding, and safety. In this respect, length of membership shows stronger effects than age and the only member value unaffected by time is that of individual economic goals. The paper closes with practical implications for the management of membership associations. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Öffentliche und Gemeinwirtschaftliche Unternehmen (ZÖgU) / Journal for Public & Nonprofit Services is the property of Nomos Verlagsgesellschaft mbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Housing co-operatives host miniature versions of civil society. They vitalize a social system that is shaped by formal regulations, economic functions and a population of private housing units. The study examines factors that influence a person’s willingness to volunteer in civic society using a multilevel analysis based on survey data from 32 co-operatives and 1263 members. To do so, the social exchange theory is extended to include the member value approach, which connects social engagement with the fulfillment of a range of needs, thus going beyond a narrow economic cost-benefit analysis. Study results show that volunteer engagement largely depends on the degree to which members can expect to experience their own achievement. This finding provides an explanation for significant differences in the engagement levels beyond factors that have already been determined (age, level of education). On an organizational level, the study reveals that the age of an organization influences volunteer engagement, but that the size and the degree of professionalization do not have an effect on it. [ABSTRACT FROM AUTHOR]

Objective: The interchangeability of continuous measurement of cardiac output (CO) with the traditional bolus method in patients after cardiopulmonary bypass (CPB) is uncertain.Design: Prospective observational clinical study.Setting: A 20-bed surgical ICU at a university hospital.Patients: Fourteen deeply sedated, ventilated, post-cardiac surgery patients, all equipped with a pulmonary artery catheter.Interventions: Six hours after the end of the CPB, 56 simultaneous bolus and continuous measurements were compared by a linear regression analysis and Bland-Altman analysis. Bolus CO was estimated by averaging triplicate injections of 10 ml room-temperature NaCl 0.9%, delivered randomly during the respiratory cycle. A stringent maximum difference of 0.55 l min(-1) (about 10% of the mean bolus measured) was considered as a clinically acceptable agreement between the two types of measurements. To be interchangeable the limits of agreement (+/-2 SD of the mean difference between the two methods) should not exceed the chosen acceptable difference.Measurements and Results: Continuous was correlated with bolus CO, with a correlation coefficient of r(2)=0.68. (p<0.01). The Bland-Altman analysis demonstrated an objective mean bias of 0.33+/-0.6 l min(-1) (confidence interval of -0.87-1.58) with 34% of measured values falling outside of the clinically acceptable limits.Conclusion: Our results suggest that, in the first 6 h after CPB, continuous and bolus CO determinations are not interchangeable; one third of the values obtained by continuous CO fell outside the strict limits of clinically useful precision. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Pädagogik is the property of Julius Beltz GmbH & Co. KG Beltz Juventa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The author comments on the stance of science, medicine and the pharmaceutical industry in the sepsis research. The author mentions the new clinical trial which examines the effects of a drug, recombinant human activated protein C, on outcome in sepsis. He cites the importance of describing the basis of a study and the decision to inform the intensive care community of the trial right from the start. He believes that the patient and community cannot be left out as they expect possible care.

The article presents information on a study related to intensive care and emergency medicine. The authors detail some of the key changes in various aspects of intensive care medicine including respiratory, cardiovascular, metabolic, and nutritional care, as well as sepsis, polytrauma, organization, and management. One of the major advances in intensive care medicine has been the advent of the large, multicenter study organized by critical or intensive care societies or a government-funded body. According to the authors, there is a need to evaluate supportive care modalities as well as new pharmacologic interventions.

Objective: Continuous positive airway pressure (CPAP) by face mask is an effective method of treating severe cardiogenic pulmonary edema (CPE). However, to our knowledge, no study has provided a precise evaluation of the effects of CPAP on cardiac function in patients presenting with CPE and preserved left ventricular (LV) function. Design: Prospective observational clinical study. Setting: A 14-bed, medical ICU at a university hospital. Patients: Nine consecutive patients presenting with hypoxemic acute CPE. Interventions: All patients were selected for 30 min of CPAP with 10 cm H2O by mask with fraction of inspired oxygen adjusted for a cutaneous saturation > 90%. Doppler echocardiography was performed before CPAP application and during the last 10 min of breathing with CPAP. Two-tailed, paired t-tests were used to compare data recorded at baseline (oxygen alone) and after CPAP. Measurements and results: Four patients presented CPE with preserved left ventricular (LV) function (a preserved LV ejection fraction [LVEF] > 45%, and/or aortic velocity time integral > 17 cm in the absence of aortic stenosis or hypertrophic cardiomyopathy). Oxygenation and ventilatory parameters were improved by CPAP in all patients. Hemodynamic monitoring and Doppler echocardiographic analysis demonstrated that in patients with preserved LV systolic function, mean arterial pressure and LV end-diastolic volume were decreased significantly by CPAP (p < 0.04). In patients with LV systolic dysfunction, CPAP improved LVEF (p < 0.05) and decreased LV end-diastolic volume (p = 0.001) significantly. Conclusion: CPAP improves oxygenation and ventilatory parameters in all kinds of CPE. In patients with preserved LV contractility, the hemodynamic benefit of CPAP results from a decrease in LV end-diastolic volume (preload). [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The accuracy and clinical utility of preload indexes as bedside indicators of fluid responsiveness in patients after cardiac surgery is controversial. This study evaluates whether respiratory changes (Δ) in the preejection period (PEP; ΔPEP) predict fluid responsiveness in mechanically ventilated patients. Sixteen postcoronary artery bypass surgery patients, deeply sedated under mechanical ventilation, were enrolled. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the radial arterial pressure. ΔPEP (%) was defined as the difference between expiratory and inspiratory PEP measured over one respiratory cycle. We also measured cardiac output, stroke volume index, right atrial pressure, pulmonary arterial occlusion pressure, respiratory change in pulse pressure, systolic pressure variation, and the Δdown component of SPV. Data were measured without positive end-expiratory pressure (PEEP) and after application of a PEEP of 10 cmH[sub 2]O (PEEP[sub 10]). When PEEP[sub 10] induced a decrease of >15% in mean arterial pressure value, then measurements were re-performed before and after volume expansion. Volume loading was done in eight patients. Right atrial pressure and pulmonary arterial occlusion pressure before volume expansion did not correlate with the change in stroke volume index after the fluid challenge. Systolic pressure variation, ΔPEP, Δdown, and change in pulse pressure before volume expansion correlated with stroke volume index change after fluid challenge (r² = 0.52, 0.57, 0.68, and 0.83, respectively). In deeply sedated, mechanically ventilated patients after cardiac surgery, ΔPEP, a new method, can be used to predict fluid responsiveness and hemodynamic response to PEEP[sub 10]. [ABSTRACT FROM AUTHOR]

Hypothesis: A set of clinical variables available at the bedside can be used to predict outcome in critically ill patients with bloodstream infection (BSI). Design: A 3-year retrospective cohort study. Setting: A surgical intensive care unit in Switzerland. Patients: All patients with BSI were potentially eligible. Main Outcome Measures: Clinical variables, organ dysfunctions, and outcome. Results: Among 4530 admissions to the surgical intensive care unit, 224 clinically significant episodes of BSI were recorded (incidence, 4.9%), with a 28-day fatality of 36%. A total of 110 patients had primary bacteremia, of which 39 (35%) were catheter related. Although grampositive organisms were the most frequently isolated pathogens (58% [159/275]), they were associated with lower case-fatality (30%) than BSI due to gram-negative bacteria (44%). Organ dysfunctions associated with the highest risk of death were neurologic dysfunction (hazard ratio [HR], 6.9; 95% confidence interval [CI], 3.314.5), hepatic dysfunction (HR, 3.9; 95% CI, 2.1-7.4), and disseminated intravascular coagulation (HR, 3.0; 95% CI, 1.5-6.1). By multivariate analysis, 2 independent predictors of mortality were the APACHE II (Acute Physiology and Chronic Health Evaluation II) score at onset of BSI (HR per 1-point increase, 1.08; 95% CI, 1.041.12) and the number of evolving organ dysfunctions (HR, 1.4; 95% CI, 1.2-1.7). Appropriate antimicrobial therapy was associated with improved outcome (HR, 0.4; 95% CI, 0.2-0.6). Conclusions: Bloodstream infection in critically ill patients is a common and frequently fatal condition. Its outcome can be predicted by the severity of illness at onset of BSI and the number of organ dysfunctions evolving thereafter. Appropriate antimicrobial therapy is an important determinant for survival. [ABSTRACT FROM AUTHOR]

Study Objectives: To describe the risk factors for the development of and mortality resulting from acute respiratory failure (ARF) in a large patient population.Design: A substudy of a prospective, multicenter, observational cohort study, which was designed to validate the sequential organ failure assessment score.Setting: Forty ICUs in 16 countries.Patients: All critically ill patients who were admitted to one of the participating ICUs during a 1-month period were observed until the end of their hospital course.Measurements and Results: Of the 1,449 patients who were enrolled into the study, 458 (32%) were admitted to an ICU with ARF, as defined by a PaO(2)/fraction of inspired oxygen ratio of < 200 mm Hg and the need for respiratory support. Patients who presented with ARF were older than the other patients (63 vs 57 years, respectively; p < 0.001) and more commonly had an infection (47% vs 20%, respectively; p < 0.001). The length of ICU stay was longer (6 vs 4 days, respectively; p < 0.001) and the ICU mortality rate was more than double (34% vs 16%, respectively; p < 0.001) in ARF patients compared to non-ARF patients. Of the 991 patients who were admitted to an ICU without ARF, 352 (35%) developed ARF later during the ICU stay. The independent risk factors for the development of ARF were infection developing in the ICU (odds ratio [OR], 7.59; 95% confidence interval [CI], 5.08 to 11.33) or present on ICU admission (OR, 2.3; 95% CI, 1.68 to 3.16), the presence of neurologic failure on ICU admission (OR, 2.73; 95% CI, 1.90 to 3.91), and older age (OR, 1.70; 95% CI, 1.30 to 2.22). Of all 810 patients with ARF, 253 (31%) died. The independent risk factors for death were multiple organ failure following ICU admission, history of hematologic malignancy, chronic renal failure or liver cirrhosis, the presence of circulatory shock on ICU admission, the presence of infection, and older age.Conclusions: The present study stresses that ARF is common in the ICU (56% of all patients) and that a number of extrapulmonary factors are related to the risk of development of ARF and to mortality rate in these patients. [ABSTRACT FROM AUTHOR]

Study objectives: To describe the risk factors for the development of and mortality resulting from acute respiratory failure (ARF) in a large patient population. Design: A substudy of a prospective, multicenter, observational cohort study, which was designed to validate the sequential organ failure assessment score. Setting: Forty ICUs in 16 countries. Patients: All critically ill patients who were admitted to one of the participating ICUs during a 1-month period were observed until the end of their hospital course. Measurements and results: Of the 1,449 patients who were enrolled into the study, 458 (32%) were admitted to an ICU with ARF, as defined by a PaO[sub 2]/fraction of inspired oxygen ratio of < 200 mm Hg and the need for respiratory support. Patients who presented with ARF were older than the other patients (63 vs 57 years, respectively; p < 0.001) and more commonly had an infection (47% vs 20%, respectively; p < 0.001). The length of ICU stay was longer (6 vs 4 days, respectively; p < 0.001) and the ICU mortality rate was more than double (34% vs 16%, respectively; p < 0.001) in ARF patients compared to non-ARF patients. Of the 991 patients who were admitted to an ICU without ARF, 352 (35%) developed ARF later during the ICU stay. The independent risk factors for the development of ARF were infection developing in the ICU (odds ratio [OR], 7.59; 95% confidence interval ICI], 5.08 to 11.33) or present on ICU admission (OR, 2.3; 95% CI, 1.68 to 3.16), the presence of neurologic failure on ICU admission (OR, 2.73; 95% CI, 1.90 to 3.91), and older age (OR, 1.70; 95% CI, 1.30 to 2.22). Of all 810 patients with ARF, 253 (31%) died. The independent risk factors for death were multiple organ failure following ICU admission, history of hematologic malignancy, chronic renal failure or liver cirrhosis, the presence of circulatory shock on ICU admission, the presence of infection, and older age. Conclusions: The present study stresses that ARF is common in the... [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety of liposomal PGE1 (TLC C-53) in patients with acute respiratory distress syndrome (ARDS), and determine its efficacy in improving oxygenation and reducing ventilator dependency. Design: A multi-centre, randomized, double-blind, placebo-controlled clinical study. Setting: Thirty-one hospitals in six European countries. Patients: One hundred two patients with ARDS. Interventions: Patients were randomized in a 2:1 ratio to receive infusions of either the study drug TLC C-53 or placebo. Infusions were given over 60 min every 6 h for 7 days. The dose of study drug started at 0.6 µg/kg per h, rising over 24 h to a maximum dose of 1.8 µg/kg per h. Measurements and main results: Seventy patients received the study drug and 32 placebo. Sixty-nine patients (47 treatment, 22 placebo) completed the study protocol. Patients were monitored for changes in the PaO2/FIO2 ratio, changes in lung compliance, time to off-ventilator and 28-day mortality, in addition to basic haematological and haemodynamic parameters. There were no significant differences in demographics and baseline characteristics between the two groups. There were no differences in the time to off-ventilation (16 days with treatment, 16.6 days with placebo, p=0.94) or in 28-day mortality (30% with treatment, 28% with placebo, p=0.78). There was a difference in the time to achieve a PaO2/FIO2 ratio above 300 in favour of TLC C-53 (10.3 versus 26.5 days) but this was not statistically significant (p=0.23). Conclusions: TLC C-53 was generally well-tolerated but failed to reduce mortality or duration of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Offers letters to the editor as of February 21, 2001. Abnormal heart rate recovery and risk of death; Treatment of respiratory failure with noninvasive continuous positive airway pressure; Asthma and psychiatric illness; Others.

Objectives: Processed EEG monitoring has been suggested for sedation depth evaluation in intensive care unit (ICU) patients. The present study investigated the efficacy of two processed EEG monitors using SEF90% or SEF95% and BIS to differentiate between conscious (Ramsay score 4) and unconscious sedation (Ramsay score 6).Design and Setting: Prospective, randomized trial in a surgical ICU of a university teaching hospital.Patients: Patients recovering from elective coronary bypass grafting.Intervention: One of two EEG analyzers was installed (A: Aspect A-1000 measuring SEF95% and BIS; D: Drager pEEG measuring SEF90%). At ICU admission unconscious sedation (Ramsay score 6), and at three 30-min intervals conscious sedation (Ramsay score 4) were investigated.Measurements and Results: Fourteen patients were monitored by A and 14 by D. The interindividual variability (coefficient of variation 32-69 %) was large for all three processed EEG methods. SEF90% of analyzer D and BIS of analyzer A showed a statistically significant difference between unconscious and conscious sedation (11 +/- 3 and 17 +/- 6 Hz, p = 0.005; 74 +/- 10 and 83 +/- 10, p = 0.02). Positive and negative predictive values for SEF90% of analyzer D (0.57, 95% CI 0.34-0.77; and 0.92, 95% CI 0.64-0.99) and BIS of analyzer A (0.55, 95 % CI 0.32-0.76; and 0.87, 95 % CI 0.60-0.98) were too low for discrimination between conscious and unconscious sedation.Conclusions: The use of processed EEG monitoring cannot be recommended for assessing sedation depth after cardiac surgery. [ABSTRACT FROM AUTHOR]

Context: Studies have shown that an inflammatory response may be elicited by mechanical ventilation used for recruitment or derecruitment of collapsed lung units or to overdistend alveolar regions, and that a lung-protective strategy may reduce this response.Objective: To test the hypothesis that mechanical ventilation induces a pulmonary and systemic cytokine response that can be minimized by limiting recruitment or derecruitment and overdistention.Design and Setting: Randomized controlled trial in the intensive care units of 2 European hospitals from November 1995 to February 1998, with a 28-day follow-up.Patients: Forty-four patients (mean [SD] age, 50 [18] years) with acute respiratory distress syndrome were enrolled, 7 of whom were withdrawn due to adverse events.Interventions: After admission, volume-pressure curves were measured and bronchoalveolar lavage and blood samples were obtained. Patients were randomized to either the control group (n = 19): tidal volume to obtain normal values of arterial carbon dioxide tension (35-40 mm Hg) and positive end-expiratory pressure (PEEP) producing the greatest improvement in arterial oxygen saturation without worsening hemodynamics; or the lung-protective strategy group (n = 18): tidal volume and PEEP based on the volume-pressure curve. Measurements were repeated 24 to 30 and 36 to 40 hours after randomization.Main Outcome Measures: Pulmonary and systemic concentrations of inflammatory mediators approximately 36 hours after randomization.Results: Physiological characteristics and cytokine concentrations were similar in both groups at randomization. There were significant differences (mean [SD]) between the control and lung-protective strategy groups in tidal volume (11.1 [1.3] vs 7.6 [1.1] mL/kg), end-inspiratory plateau pressures (31.0 [4.5] vs 24.6 [2.4] cm H2O), and PEEP (6.5 [1.7] vs 14.8 [2.7] cm H2O) (P<.001). Patients in the control group had an increase in bronchoalveolar lavage concentrations of interleukin (IL) 1beta, IL-6, and IL-1 receptor agonist and in both bronchoalveolar lavage and plasma concentrations of tumor necrosis factor (TNF) alpha, IL-6, and TNF-alpha, receptors over 36 hours (P<.05 for all). Patients in the lung-protective strategy group had a reduction in bronchoalveolar lavage concentrations of polymorphonuclear cells, TNF-alpha, IL-1beta, soluble TNF-alpha receptor 55, and IL-8, and in plasma and bronchoalveolar lavage concentrations of IL-6, soluble TNF-alpha receptor 75, and IL-1 receptor antagonist (P<.05). The concentration of the inflammatory mediators 36 hours after randomization was significantly lower in the lung-protective strategy group than in the control group (P<.05).Conclusions: Mechanical ventilation can induce a cytokine response that may be attenuated by a strategy to minimize overdistention and recruitment/derecruitment of the lung. Whether these physiological improvements are associated with improvements in clinical end points should be determined in future studies. [ABSTRACT FROM AUTHOR]