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Background: Refeeding syndrome (RFS) is a potentially life-threatening condition that can occur in preterm infants if nutritional support is initiated or increased after a period of starvation or malnutrition., Objectives: The current study aimed to examine the short-term clinical outcomes of RFS in preterm infants born at ≤32 weeks of gestation., Methods: Infants with a gestational age of ≤32 weeks and a birth weight of <1500 g who were born and admitted to the level III neonatal intensive care unit and received parenteral nutrition upon admission were retrospectively evaluated. The modified log Poisson regression with generalized linear models and a robust variance estimator was applied to adjust the outcomes of infants., Results: In total, 760 infants met this study's inclusion criteria. Of them, 289 (38%) developed RFS. RFS was significantly associated with a composite outcome of mortality and intraventricular hemorrhage. Based on the multivariate Cox regression analysis adjusted for significant potential confounders, RFS was significantly associated with increased mortality risk, with a hazard ratio for death in infants with RFS being 1.74-fold higher compared to those without RFS., Conclusions: Preterm infants born at ≤32 weeks of gestation who develop RFS within the first week of life are at increased risk for both intraventricular hemorrhage and mortality. This study underscores the need for standardized clinical approaches for managing RFS in the neonatal intensive care unit to improve outcomes. Future research should establish a unified RFS definition and conduct clinical trials to optimize parenteral nutrition strategies for this vulnerable population.

To investigate the combined effect of hyperglycemia and hypoglycemia on intraventricular hemorrhage (IVH) and mortality recognizing that previous research has predominantly focused on examining these conditions independently. This study included very preterm infants who were born at King Saud Medical City, a tertiary referral center, and admitted to a level 3 neonatal intensive care unit between January 2020 and January 2024. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber-White) were used to adjust for potential confounding factors. A total of 554 infants met the inclusion criteria. Hyperglycemia and/or hypoglycemia developed in 75.5% (418) patients within the first postnatal week. During the study period, IVH occurred in 28.5% (N = 158), and severe IVH occurred in 13% (72) infants. In addition, 13.7% (76) of infants died during the study period. The multivariate regression revealed an association between the isolated hyperglycemia, combined exposure of hypo- and hyperglycemia, and development of IVH (relative risk [RR], 2.10; 95% confidence interval [CI], 1.36, 3.25; RR, 2.33; 95% CI, 1.34, 4.06, respectively). Severe IVH was significantly associated with isolated hyperglycemia (adjusted relative risk [aRR], 2.46; 95% CI, 1.16, 5.23). Death was associated with combined hypo- and hyperglycemia (adjusted hazardous ratio [aHR], 3.19; 95% CI, 1.23, 8.26).Conclusion: Combined hyper- and hypoglycemia in the first week of life of premature babies increases the risk and severity of IVH and neonatal mortality., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This study aimed to investigate the relationship between acute kidney injury (AKI) in the first 2 weeks of life and brain injury on term-equivalent age magnetic resonance imaging in very preterm infants., Methods: We included 116 infants with a birth weight of < 1500 g who were born at the King Saud Medical City at ≤ 32 gestational weeks. They were admitted to the neonatal intensive care unit and underwent term-equivalent age and pre-discharge brain magnetic resonance imaging. A negative binomial with generalized linear models and a robust variance estimator (Huber-White) was applied for univariate relative risk analysis. The Kidokoro score was then used to determine the effect of AKI on brain morphology and growth at term-equivalent age., Results: Sixty-eight (64.2%) infants had developed an AKI in the first 2 weeks of life. AKI was significantly associated with cerebellum signal abnormalities, cerebellar volume reduction, and a high total cerebellum score (P = 0.04, P < 0.001, P < 0.001, respectively)., Conclusions: AKI in the first 2 weeks of life is associated with brain insult, especially in the cerebellum. More well-designed studies are required to investigate the association and impact of AKI on the central nervous system. A higher resolution version of the Graphical abstract is available as Supplementary information., (© 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)

The soybean oil, medium-chain triglycerides, olive oil, and fish oil lipid (SMOFlipid) is increasingly being used worldwide without definite evidence of its benefits. We examined the effect of SMOFlipid on growth velocity and neonatal morbidities in very preterm infants. Very preterm infants who received soybean-based lipid emulsion between January 2015 and 2018 were compared with those who received SMOFlipids between 2019 and January 2022 in our neonatal tertiary center. Linear regression analysis was conducted to analyze the association between type of lipid emulsion and growth velocity. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber−White) were applied to adjust for potential confounding factors. A total of 858 infants met our inclusion criteria. Of them, 238 (27.7%) received SMOFlipid. SMOFlipid was associated with lower growth velocity between birth and 36-week corrected gestational age compared with intralipid Δ weight z-score (adjusted mean difference (aMD) −0.67; 95% CI −0.69, −0.39). Subgroup analysis indicated that mainly male infants in the SMOFlipid−LE group had a lower Δ weight z-score compared to those in the intralipid group (p < 0.001), with no difference observed in females (p = 0.82). SMOFlipid was associated with a lower rate of bronchopulmonary dysplasia (BPD) (aRR 0.61; 95% CI 0.46, 0.8) and higher rate of late-onset sepsis compared with intralipid (aRR 1.44; 95% CI 1.22−1.69). SMOFlipid was associated with lower growth velocity and BPD but higher rate of late-onset sepsis—it is a double-edged sword.

To investigate the relationship between morphine exposure in the first week of life and brain injury on term-equivalent age magnetic resonance imaging (MRI) in very preterm infants. A retrospective study included 106 infants with a birth weight of < 1500 g who were born at King Saud Medical City at ≤ 32 gestational weeks, were admitted to the neonatal intensive care unit, and underwent term-equivalent age or pre-discharge brain MRI. A univariate analysis in addition to modified log-Poisson regression with a robust variance estimator was applied, and the effect of early morphine exposure and cumulative dose in the first seven days on brain morphology and growth at term-equivalent age was determined using the Kidokoro score. Sixty-eight (64.2%) infants had received morphine in the first week of life (median cumulative dose: 1.68 mg/kg, interquartile range 0.48-2.52 mg/kg). Early initiation of morphine administration was significantly associated with high total white matter (adjusted relative risk [aRR] 1.32, 95% confidence interval [CI] 1.01-1.72) and cerebellum (aRR 1.36, 95% CI 1.03-1.81) scores and a small cerebellar volume (aRR 1.28, 95% CI 1.02-1.61). Morphine exposure in the first week of life was independently associated with white matter and cerebellar injury on term-equivalent age brain MRI in very preterm infants., (© 2022. The Author(s).)

The increasing use of carbapenems has contributed to a notable distribution of carbapenem-resistant Enterobacteriaceae (CRE). Recently, the incidence of CRE-associated infections is increasing significantly in NICUs, which pose a grave challenge to clinical treatment. We report 2 cases of IV ceftazidimeavibactam use to treat CRE infections in extremely premature neonates. The first case was diagnosed with bacteraemia and meningitis and the second one was diagnosed with bacteraemia only. Due to the lack of neonatal-specific information for IV ceftazidime-avibactam, the usual pediatric dose (62.5 mg/kg/dose every 8 hours) was used in these patients. Clinical cure occurred in these 2 patients. Although blood cultures became sterile after starting ceftazidime-avibactam in the second case, the patient died, presumably owing to sepsis or various causes, such as prematurity and chronic lung disease. Large and randomized studies are necessary to ensure the safety and efficacy of IV ceftazidime-avibactam for the treatment of neonates with sepsis caused by multidrug resistant organisms., Competing Interests: Disclosures. The authors declare no conflicts of interest in any product mentioned in manuscript, including grants and medications. Authors have full access to all patient information in this report and take responsibility for the integrity and accuracy of the report., (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2022.)

Intraventricular hemorrhage (IVH) and acute kidney injury (AKI) are important neonatal morbidities in premature infants. This study aimed to investigate the relationship between IVH and AKI in premature infants and whether this association affects the incidence of neonatal mortality. Infants [gestational age (GA) ≤ 32 weeks; birth weight (BW) < 1500 g] were retrospectively evaluated in a large tertiary neonatal intensive care unit. Of 710 premature infants, 268 (37.7%) developed AKI. Infants with IVH were more likely to have AKI than those without IVH. Infants with severe IVH had a higher incidence of AKI than infants with mild IVH. Infants younger than 28 weeks with IVH were more likely to have AKI than those without IVH. An association between IVH grades and AKI stages was observed in the overall study population, in infants with GA < 28 weeks, and in infants with GA between 28 and 32 weeks. Mortality was increased 1.5 times in infants with IVH and AKI compared with that in infants with IVH but without AKI. Furthermore, mortality was increased in infants with IVH and AKI compared with infants without IVH or AKI. This study shows a direct relationship between the severity of IVH and the degree of AKI; both IVH and AKI increase the incidence of neonatal mortality.

Background: Intraventricular hemorrhage (IVH) is a serious complication of premature (<32 weeks) deliveries, especially in very-low-birth-weight (VLBW; <1500 g) neonates. Infants developing severe IVH are more prone to long-term developmental disabilities. Although 62%-79% of women in Saudi Arabia receive antenatal steroids, IVH incidence remains high. We analyzed the risk factors for IVH in preterm VLBW neonates in the central region of Saudi Arabia., Methods: We included premature infants with IVH (n = 108) and gestational age- and birth weight-matched control group infants (n = 108) admitted to our neonatal intensive care unit. Cases were divided into mild (grades I and II; n = 56) and severe (grades III and IV; n = 52) IVH groups. Association of IVH with risk factors in the first week of life was investigated., Results: The following risk factors were associated with severe IVH: lack of antenatal steroid administration ( P < .001), pulmonary hemorrhage ( P  = .023), inotrope use ( P  = .032), neonatal hydrocortisone administration ( P  = .001), and patent ductus arteriosus (PDA) ( P  = .005). Multivariable logistic regression analysis revealed the following to be significant: lack of antenatal dexamethasone (adjusted odds ratio [aOR]: 0.219, 95% confidence interval [95% CI] 0.087-0.546), neonatal hydrocortisone administration (aOR: 3.519, 95% CI 1.204-10.281), and PDA (aOR: 2.718, 95% CI 1.024-7.210). Low hematocrit in the first 3 days of life was significantly associated with severe IVH (all P < .01)., Conclusions: Failure to receive antenatal dexamethasone, PDA, hydrocortisone administration for neonatal hypotension, and low hematocrit in the first 3 days of life was associated with severe IVH in VLBW neonates. Clinicians and healthcare policy makers should consider these factors during decision-making., (© 2019 Publishing services provided by Elsevier B.V. on behalf of King Faisal Specialist Hospital & Research Centre (General Organization), Saudi Arabia.)

Congenital junctional ectopic tachycardia is a rare and special type of supraventricular arrhythmia. Junctional ectopic tachycardia is characterized by persistently elevated heart rates that may cause an impairment in cardiac function. Junctional ectopic tachycardia is considered one of the most difficult-to-treat conditions even with a combination of antiarrhythmic medications. Ivabradine is a novel antiarrhythmic medication used to decrease the heart rate in adults with angina pectoris. We report a first case of a premature neonate with a normal heart structure who developed junctional ectopic tachycardia and was subsequently treated successfully with ivabradine., Competing Interests: Disclosures. The authors declare no conflicts of interest in any product mentioned in the manuscript, including grants and medications. Authors have full access to all patient information in this report and take responsibility for the integrity and accuracy of the report., (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2021.)

Objective: Daptomycin is a lipopeptide antibiotic with rapid bactericidal activity against Gram-positive bacteria. Reports regarding the use of daptomycin in infants are still limited. Thus, the objective of this report is to describe the safety and efficacy of daptomycin in premature infants with persistent coagulase-negative staphylococci (CoNS) infection., Methods: This was a retrospective chart review of 10 premature infants with persistent CoNS infection who received daptomycin therapy between January 2018 and September 2019. Four patients had endocarditis and 1 had bacterial meningitis and infectious endocarditis. The other 5 patients had persistent CoNS bacteraemia only., Results: Daptomycin treatment was successful for 5 patients. The others died owing to multiple factors such as prematurity, sepsis, and chronic lung disease. Adverse drug reactions, including elevation of creatine phosphokinase and/or hepatotoxicity, were noted in 4 patients., Conclusions: Large and randomized studies are necessary to ensure daptomycin's safety and efficacy for the treatment of infants with persistent sepsis caused by Gram-positive bacteria., Competing Interests: Disclosure. The authors declare no conflicts of interest in any product mentioned in manuscript, including grants and medications. Authors have access to all the data in the study and take responsibility for the integrity and the accuracy of the data analysis., (Copyright Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2021.)

Relieving neonatal pain is essential for the management of premature infants. Morphine is the most frequently used analgesic in neonatal intensive care. Here we report the relationship between early morphine infusion and the composite outcome of intraventricular hemorrhage and/or death in intubated premature infants. Infants (gestational age ≤ 32 weeks and birth weight < 1,500 g) intubated on admission were retrospectively evaluated in a large tertiary neonatal intensive care unit. Modified log-Poisson regression with robust variance estimator and Cox regression was applied to adjust the relative risk for infants' outcomes. Of 420 premature infants, 230 (54.7%) received continuous morphine infusion in the first 72 h. Of these, 153 were < 28 gestational weeks; of the 190 patients who did not receive morphine, 63 were < 28 gestational weeks. The analysis revealed that infants < 28 gestational weeks who received morphine were significantly associated with an increased risk for IVH and/or death [adjusted relative risk (aRR) 1.37, 95% confidence interval (CI) 1.1-1.71)], and mortality (aRR 1.83, 95% CI 1.17-2.89). Moreover, in infants < 28 gestational weeks, survival was low in those infants who were exposed to morphine infusion in the first 72 h (hazard ratio 2.11; 95% CI 1.19-3.73). Early morphine infusion is associated with an increased risk for IVH and/or death; however, further studies are required to verify our findings.

Background: Premature non-Saudi infants comprise a significant proportion of neonatal intensive care unit admissions in Saudi Arabia. Any differences in antenatal care of mothers and neonatal outcomes compared with premature Saudi infants are unreported., Objective: Assess antenatal care of mothers and neonatal outcomes among premature Saudi and non-Saudi infants, and investigate possible reasons for disparities., Design: Retrospective cohort study., Setting: Tertiary care center in Riyadh., Patients and Methods: All neonates of gestational age ≤32 weeks and birthweight <1500 g admitted from 2015 to 2019 were included., Main Outcome Measures: Antenatal care of mothers and rates of neonatal mortality and morbidity in premature Saudi and non-Saudi infants., Sample Size: 755 premature infants, 437 (57.9%) Saudi, 318 (42.1%) non-Saudi., Results: Saudi mothers received more antenatal steroids and were more likely to have gestational diabetes mellitus ( P =.01 and .03, respectively). Non-Saudi mothers were more likely to have pregnancy-induced hypertension ( P =.01). Non-Saudi infants had significantly higher rates of intraventricular hemorrhage, patent ductus arteriosus, pulmonary hemorrhage, bronchopulmonary dysplasia and necrotizing enterocolitis compared with Saudi infants ( P =.03, <.001, .04, .002, and <.001, respectively). There were no significant differences in mortality rate, early-onset sepsis, and late-onset sepsis between Saudi and non-Saudi infants ( P =.81, .81, and .12, respectively)., Conclusions: Disparities exist in the antenatal care of Saudi and non-Saudi women and in the neonatal morbidities of their premature infants. There was no difference in the neonatal mortality rate. More quality improvement initiatives are required to reduce differences in antenatal and neonatal outcomes., Limitations: Retrospective, socioeconomic disparities not identified., Conflict of Interest: None.

Confined animal feeding operations (CAFOs) contribute to greenhouse gas emission, but the magnitude of these emissions as a function of operation size, infrastructure, and manure management are difficult to assess. Modeling is a viable option to estimate gaseous emission and nutrient flows from CAFOs. These models use a decomposition rate constant for carbon mineralization. However, this constant is usually determined assuming a homogenous mix of manure, ignoring the effects of emerging manure treatments. The aim of this study was to measure and compare the decomposition rate constants of dairy manure in single and three-pool decomposition models, and to develop an empirical model based on chemical composition of manure for prediction of a decomposition rate constant. Decomposition rate constants of manure before and after an anaerobic digester (AD), following coarse fiber separation, and fine solids removal were determined under anaerobic conditions for single and three-pool decomposition models. The decomposition rates of treated manure effluents differed significantly from untreated manure for both single and three-pool decomposition models. In the single-pool decomposition model, AD effluent containing only suspended solids had a relatively high decomposition rate of 0.060 d(-1), while liquid with coarse fiber and fine solids removed had the lowest rate of 0.013 d(-1). In the three-pool decomposition model, fast and slow decomposition rate constants (0.25 d(-1) and 0.016 d(-1) respectively) of untreated AD influent were also significantly different from treated manure fractions. A regression model to predict the decomposition rate of treated dairy manure fitted well (R(2) = 0.83) to observed data., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: As a person ages, leg speed and power decrease. These changes are associated with increased falls and reduced gait speed. It has been shown that upper leg training in younger persons results in increased strength and power at the specific speed at which resistance training is applied, although there are only limited data concerning speed-specific training effects on lower leg activity. However, because both upper and lower leg speed and power influence gait and balance, it is important to determine the training speeds that selectively improve these variables in older persons., Methods: No studies have examined selective speed-specific changes in performance for the upper and lower leg muscles in older individuals. Therefore, we compared shifts in the power-velocity relationship after high-speed (HS) and low-speed (LS) isokinetic training of knee extensors (KE) and flexors (KF), dorsiflexors (DF), and plantar flexors (PF) in community-dwelling women (ages 61 to 75). Subjects were randomly assigned to a HS training, LS training, or control (C) group. Training occurred three times a week for 12 weeks. HS training occurred at 4.73 rad.s(-1) (knee) and 3.14 rad.s(-1) (ankle); LS training for both joint actions was at 1.05 rad.s(-1)., Results: HS training improved KE power at intermediate (3.14 rad.s(-1); p =.0007) and high (5.24 rad.s(-1); p =.0004) testing speeds. Neither the HS nor LS group showed any change in KF as a result of the training. Both LS and HS training improved DF power at all testing speeds; however, PF power improved only with LS training and only at 1.05 rad.s(-1) (p =.0132) and 3.14 rad.s(-1) (p =.0310)., Conclusions: Our results suggest that, in older women, lower leg training should occur at lower training speeds than upper leg training. Additionally, attention to differential speed-specific training of knee and ankle actions could improve power production, mobility, balance, and other functional measures in older persons.

Researchers and practitioners, as well as vendors, have placed much emphasis on what constitutes a functional capacity testing battery. Statistical, procedural, behavioral, technological, as well as legal issues surrounding this type of human performance evaluation are also continuously being addressed in the literature. In addition, several methods, batteries, equipment, and protocols have been developed for the purpose of evaluating what an injured person can or cannot do. It is a fact that 'testing' of individuals is but one component of an intricate process consisting of: identification of an evaluee, researching a market, referring the evaluee to a facility, evaluating a set of abilities, making inference about the evaluee's performance, reporting the findings, following up on the case, and possibly a legal involvement due to litigation. These components comprise the process of functional capacity testing. The purpose of this paper is to describe and analyze the various components of the process of quantitative testing of functional capacity. It is believed that each component of the FCA process is as important as the actual testing.

Literature evidence indicates that physicians have great difficulty in translating medical impairment into functional limitation and thereby establishing the work capacity or the residual functional capacity (RFC) of the injured worker. This is especially true for the chronic pain patient (CPP). Development of quantitative methods for the measurement of functional capacity (FC), have not improved the problems involved in the measurement of RFC and the translation of RFC into the demand minimum functional capacity (DMFC) of some job or jobs. The relationship between FC, RFC, work capacity and DMFC is reviewed. We have developed a method/battery for measuring RFC in CPPs utilizing the Dictionary of Occupational Titles (DOT) which is readily translatable into DMFC of some job or jobs. Suggestions are made for future directions in the measurement of work capacity.

Studies of the effects of physical exercise programs have shown that such programs can improve older persons' functional capacity. Research was conducted to determine the efficacy of two different types of physical restoration regimens--active and passive--in improving the performance of elderly persons with chronic pain conditions. Data from elderly persons admitted for back and pain rehabilitation to the Comprehensive Pain and Rehabilitation Center (CPRC) at the University of Miami are presented. The active approach consisted of the aggressive rehabilitation program at the CPRC, a 4-week program of daily physical therapy, occupational therapy, behavioral modification, and counseling. Treatment goals were improved strength, flexibility, posture, balance, gait, and overall well-being. The passive approach was based on the use of functional electric stimulation (FES) as an adjunct treatment to strengthen lower extremity muscles weakened by disuse. To evaluate the effectiveness of these approaches to physical restoration, we performed ergonomic assessment of subjects' functional abilities, including static strength and range of motion. Findings indicated that both methods were valuable in physical restoration in the elderly. Specifically FES proved effective in strengthening weak muscles in the lower extremities and shows great potential for neuromuscular conditioning in older cohorts.

Eighteen chronic pain patients (CPPs) with postradiculopathy-associated muscle weakness were entered into a nonrandomized functional electrical stimulation (FES) clinical treatment study to determine if FES can improve postradiculopathy associated muscle weakness. Because of the clinical nature of the unit, the CPPs could not be denied treatments other than FES. To control for these other treatments, the CPPs were used as their own controls with two control conditions, ie, where possible, the contralateral probable normal muscle was used as a control (control 1) and; in a subgroup of CPPs (n = 6), FES treatment was initially withheld to the probable weak muscle (control 2). Strength was measured as isometric maximum voluntary contraction (IMVC) and was used as the outcome treatment variable. IMVC was measured in both the probable weak and contralateral probable normal muscles at entrance into the Pain Center, at beginning of FES treatment, at completion of FES treatment, and for the control 2 condition at the end of the non-FES treatment period. Statistical analyses of the IMVC strength results using the two control conditions indicated (1) both the FES-treated and untreated muscles increased significantly in IMVC strength, (2) improvement in IMVC strength for FES-treated muscles was significantly greater than for probable normal FES-untreated muscles and, (3) improvement in IMVC strength in FES-treated muscles was significantly greater during the FES-treatment period than during the non-FES treatment period. FES treatment of postradiculopathy-associated muscle weakness in CPPs seems to increase the strength of the probable weak muscle above the increase in strength provided by other concurrent treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: The pain physician is often asked to establish the medical impairment of the chronic pain patient (CPP) and from that determination ascertain the work capacity of the CPP. Functional capacity (FC) testing has recently been introduced as a more objective and accurate way of facilitating the determination of work capacity. However, there are conceptual problems with the measurement of FC. These will be reviewed and the relationship of FC to residual functional capacity (RFC) will be determined. Finally, a method for measuring RFC in a job-specific manner will be suggested., Data Sources: The literature in reference to the measurement of medical impairment, FC, and RFC was reviewed., Study Selection: Studies appropriate to the objective of this review were selected for inclusion., Conclusions: The FC and RFC are poorly defined. Lack of definition has interfered with design of appropriate test batteries specific to work capacity. To circumvent this problem a job-specific RFC measurement method is suggested. This method is based on the Dictionary of Occupational Titles.

Spinal compression tolerance limits (SCTL) have been widely used by ergonomists in setting work tolerance limits for manual materials handling (MMH) operations. Thus, the effect of personal and experimental factors on spinal compression tolerance limits (SCTL) is reviewed with the aid of regression and correlation analyses performed on data compiled from the published literature. Tables of SCTL from various sources utilizing large number of specimens and personal factors are presented so that they can be accessed by ergonomists easily. Integrated biomechanical guidelines based on SCTL are provided for the design of MMH operations in the workplace. It is suggested that, in order to reduce the probability of MMH injuries, biomechanical tolerance limits should be set at the damage load instead of the load at fracture. The damage load is the weight which causes the first gross signs of damage such as tissue fluid and blood. An algorithm is described to demonstrate the use of a biomechanics approach to the design of MMH operations.

The prediction of return to the workplace after Multidisciplinary Pain Center (MPC) treatment has become a major research area. To delineate the variables that predict this outcome, the authors reviewed 164 multidisciplinary variables studies. Of these, 79 addressed work as an outcome variable. Twenty-six studies attempted to identify patient variables predicting return to the workplace. These latter studies were critically inspected for eight methodological criteria: pain location, follow-up time interval, response percentage and follow-up method, return to work subcategorization, vocational movement, univariate vs. multivariate statistics, multi-colinearity and variance, and statistical treatment of dropouts. In addition, other disability studies besides those in the chronic pain area were reviewed for return to the workplace predictor variables. Of these 26 studies, only a few appeared to satisfy the criteria examined. In addition, many studies were in conflict with one another on whether a variable was predictive. The review of the nonchronic pain/disability prediction literature yielded a large number of potential predictors that related to the work area. It is unclear which variables or set of variables predict return to the workplace after MPC treatment. Chronic pain studies may be neglecting the work area as an important source of return to the workplace predictor variables.

The major objective of this investigation was to study the effectiveness of the physical conditioning program used at the University of Miami Comprehensive Pain and Rehabilitation Center in restoring certain elements of the functional abilities of individuals suffering from chronic low-back pain and to evaluate the effectiveness of using a systematically applied, aggressive stretching maneuver as an add-on therapy in the treatment of chronic low-back pain patients. The effect(s) of the proposed stretching maneuver was evaluated. Twenty-eight chronic low-back pain patients were randomly assigned to one of two groups. The control group underwent a multimodal rehabilitation program, and the experimental group underwent the same rehabilitation program in addition to the systematic stretching maneuver under investigation. The results obtained showed that patients undergoing the multimodal rehabilitation program with and without the proposed systematic stretching maneuver showed a significant improvement in their functional abilities as seen from the significant increase in the static strength of the back extensors, with corresponding significant increase in back muscle myoelectric signals. Also, a significant decrease in their pain level was reported after 2 weeks of continuous treatment. The use of the systematic stretching maneuver enhanced the functional gains of chronic low-back pain patients compared to the control group.

This paper describes a personal microcomputer model to match the need of the ambulatory disabled to the physical workplace. It is noted that back pain resulting from working from wheelchairs is the most common complaint of many who continue or return to work. The use of computer-aided design in matching the person to his/her workstation is described.

This study was undertaken to investigate the use of electromyography (EMG) biofeedback as an add-on therapy to standard exercise in the restoration of the functional abilities of the trunk extensor muscles in patients suffering from chronic low-back pain (CLBP). A controlled experimental investigation was conducted to study the effectiveness of using the proposed treatment modality in the management of the low-back pain problem. The results obtained indicate that the proposed methodology was an effective tool to achieve a significant improvement in the strength of lumbar paraspinal muscles of chronic low-back pain patients.

This paper summarizes the research conducted to study human performance and recovery under prolonged, whole-body, vertical vibration. The results showed that performance under vibratory environment is inferior to that under normal environment. Interaction between work-rest schedules and the vibratory environment was detected. Parameters affecting selection of optimum work-rest schedules are discussed.

The main objective of the present study was to determine the effects on cardiovascular stress of tasks that have varying degrees of static and dynamic components (weight holding, manual lifting and stepping). Heart rate, oxygen consumption and blood pressure were used as indices of cardiovascular stress. The results showed that oxygen consumption and heart rate responses to manual lifting are significantly lower than those of stepping and higher than those of weight holding. A low frequency lifting task evoked significantly lower systolic blood pressure than a high frequency lifting task. This study supported the idea that a physiologic fatigue criterion (PFC) based on stepping should not be applied directly to tasks such as manual lifting. In addition, a PFC for manual lifting should not be based only on oxygen consumption or heart rate; it also should incorporate systolic blood pressure as one of the monitored stress factors in setting lifting standards.

Two different experiments were conducted to study the effects of frequency, height and load of lift on computed maximal oxygen uptake and to compare the data obtained to a standard bicycle ergometer. A progressive submaximal technique was used to predict maximal oxygen uptake. The results of the present study revealed that across all heights, an increase in either the frequency of lift or load of lift was accompanied by an increase in computed maximal oxygen uptake; however, all maximal oxygen uptake values reported showed a tendency to level off beyond the frequency of five lifts/min. The results also showed that combined arm and leg lifting recorded the highest maximal oxygen uptake followed by leg lifting then arm lifting, respectively. Maximal oxygen uptake values obtained for lifting tasks were much lower than those obtained for a bicycle ergometer. It is therefore recommended that limits for continuous work for a lifting task be based on the attainable maximal oxygen uptake for that particular task and not on a maximal oxygen uptake obtained from another task such as a bicycle ergometer test.

Numerous reports have documented the usefulness of functional electric stimulation (FES) in restoring and/or improving the function of organically diseased or paralyzed muscles. There are few reports related to the use of FES in the treatment of conversion disorder paralysis of the hysterical type. This paper presents a case of hysterically paralyzed muscles where the patient received daily treatment with FES for two weeks. Electric current was applied to a weak quadriceps and to paralyzed tibialis anterior muscles. This electrotherapeutic modality was effective in improving the function of the quadriceps and in reversing the paralysis of the tibialis anterior muscles. The improvement in the muscles' functional abilities was documented through the use of quantitative measures of muscle strength as well as computerized analysis of EMG signals. The results showed that the administration of FES resulted in a dramatic increase in motor units recruitment, increased muscle strength, and improved voluntary muscle control.

The main objective of this study was to test the differences among four techniques for the determination of lifting abilities. This study introduced a new submaximal isometric strength testing technique. The proposed test was based on the concept of acceptable maximum effort (AME) which is the level of static exertion the individual is willing to perform voluntarily and comfortably without over-exertion (as opposed to the maximum ability of performance). Twelve male and five female subjects underwent the protocol of the four strength testing techniques investigated: isometric maximum voluntary contraction (MVC); maximum acceptable weight (MAW); maximum dynamic lifting (MDL); and acceptable maximum effort (AME). The results showed that MAW recorded the lowest values followed by AME, then MDL, then MVC. The correlation between AME and MAW was higher than that found between MVC and MAW. Also, it was found that AME is a reproducible measure of muscular functional abilities. On the average, the coefficient of variation was less than 15% for data for both males and females. The implications of these results in determining lifting abilities are discussed.

Conversion paralysis has a poor prognosis when there is evidence of nonresponse to previous treatment, long duration, and secondary atrophy of the "paralyzed" muscles. The authors present four such cases in which conversion paralysis was treated successfully by means of electromyographic (EMG) biofeedback. Each of the four patients also suffered from a chronic pain condition. Results from statistical analyses indicated that the four patients demonstrated significant improvement in the functional capacity of the "paralyzed" muscles as measured by isometric maximum voluntary contraction and EMG activity. The improvements occurred without explicit psychotherapy and suggest that behavioral modification techniques alone may be helpful in such cases.

A new quantitative method for measuring functional abilities of chronic low-back pain patients is introduced. The method is based upon a psychophysical model referred to as acceptable maximum effort (AME). AME is the highest level of voluntary effort that a person can achieve without inducing unacceptable pain. In the current study, the AME method was applied to strength measurement. By use of a static strength measurement procedure, arm, leg, shoulder, back, and composite strengths were assessed upon admission to and discharge from a 4-week, nonsurgical comprehensive pain treatment program. The reliability of the AME method for each strength measure was assessed. In addition, the method was used to evaluate pre- to post-treatment changes in strength. Results indicate the AME method to be highly reliable and useful in determining treatment outcome. Reliability coefficients for all strength measures were above .90. The results are discussed in terms of their implications for standardized functional ability measurement in the area of chronic pain.