An analysis of movement patterns in mass casualty incident simulations.

BACKGROUND: Mass casualty incidents (MCI) such as train or bus crashes, explosions, collapses of buildings, or terrorist attacks result in rescue teams facing many victims and in huge challenges for hospitals. Simulations are performed to optimize preparedness for MCI. To maximize the benefits of MCI simulations, it is important to collect large amounts of information. However, a clear concept and standardization of a data-driven post-exercise evaluation and debriefing are currently lacking. METHODS: GPS data loggers were used to track the trajectories of patients, medics, and paramedics in two simulated MCI scenarios using real human actors. The distribution of patients over the treatment area and their time of arrival at the hospital were estimated to provide information on the quality of triage and for debriefing purposes. RESULTS: The results show the order in which patients have been treated and the time for the individual arrivals as an indicator for the triage performance. The distribution of patients at the accident area suggested initial confusion and unclear orders for the placement of patients with different grades of injury that can be used for post-exercise debriefing. The dynamics of movement directions allowed to detect group behavior during different phases of the MCI. CONCLUSIONS: Results indicate that GPS data loggers can be used to collect precise information about the trajectories of patients and rescue teams at an MCI simulation without interfering with the realism of the simulation. The exact sequence of the deliverance of patients of different triage categories to their appropriate destinations can be used to evaluate team performance for post-exercise debriefing. Future MCI simulations are planned to validate the use of GPS loggers by providing "hot-debrief" immediately after the MCI simulation and to explore ways in which group detection can provide relevant information for post-exercise evaluations. TRIAL REGISTRATION: Not applicable.

TKA patients experience less improvement than THA patients at 3 and 12 months after surgery. A retrospective observational cohort study.

PURPOSE: To investigate whether WOMAC scores changes after THA or TKA are gender and joint specific. METHODS: Retrospective cohort study. The data of 855 THA and 684 TKA patients were analyzed. RESULTS: Follow-up time (p < 0.001), gender (p < 0.001), joint (p < 0.001), and interaction FU by joint (p < 0.001) had significant effects on WOMAC total and sub-scores. Patients after TKA perceived less improvement in all dimensions in comparison to THA patients (p < 0.001). CONCLUSION: WOMAC score changes after THA or TKA are joint-specific. Patients after TKA perceived less improvement. These results can be used to adjust patients' expectations.

Effect of Psycho-Regulatory Massage Therapy on Pain and Depression in Women with Chronic and/or Somatoform Back Pain: A Randomized Controlled Trial.

Chronic unspecific back pain (cBP) is often associated with depressive symptoms, negative body perception, and abnormal interoception. Given the general failure of surgery in cBP, treatment guidelines focus on conservative therapies. Neurophysiological evidence indicates that C-tactile fibers associated with the oxytonergic system can be activated by slow superficial stroking of the skin in the back, shoulder, neck, and dorsal limb areas. We hypothesize that, through recruitment of C-tactile fibers, psycho-regulatory massage therapy (PRMT) can reduce pain in patients with cBP. In our study, 66 patients were randomized to PRMT or CMT (classical massage therapy) over a 12-week period and tested by questionnaires regarding pain (HSAL= Hamburger Schmerz Adjektiv Liste; Hamburg Pain adjective list), depression (BDI-II = Beck depression inventory), and disability (ODI = Oswestry Disability Index). In all outcome measures, patients receiving PRMT improved significantly more than did those receiving CMT. The mean values of the HSAL sensory subscale decreased by -51.5% in the PRMT group compared to -6.7% in the CMT group. Depressive symptoms were reduced by -55.69% (PRMT) and -3.1% (CMT), respectively. The results suggest that the superiority of PRMT over CMT may rely on its ability to activate the C-tactile fibers of superficial skin layers, recruiting the oxytonergic system.

Sensor Positioning Influences the Accuracy of Knee Rom Data of an E-Rehabilitation System: A Preliminary Study with Healthy Subjects.

E-rehabilitation is the term used to define medical rehabilitation programs that are implemented at home with the use of information and communication technologies. The aim was to test whether sensor position and the sitting position of the patient influence the accuracy of knee range of movement (ROM) data displayed by the BPMpathway e-rehabilitation system. A preliminary study was conducted in a laboratory setting with healthy adults. Knee ROM data was measured with the BPMpathway e-rehabilitation system and simultaneously with a BIOPAC twin-axis digital goniometer. The main outcome was the root mean squared error (RMSE). A 20% increase or reduction in sitting height led to a RMSE increase. A ventral shift of the BPMpathway sensor by 45° and 90° caused significant measurement errors. A vertical shift was associated with a diminution of the measurement errors. The lowest RMSE (2.4°) was achieved when the sensor was placed below the knee. The knee ROM data measured by the BPMpathway system is comparable to the data of the concurrent system, provided the instructions of the manufacturer are respected concerning the sitting position of the subject for knee exercises, and disregarding the same instructions for sensor positioning, by placing the sensor directly below the knee.

Common neural systems for contact heat and laser pain stimulation reveal higher-level pain processing.

Our current knowledge of pain-related neuronal responses is largely based on experimental pain studies using contact heat or nontactile laser painful stimulation. Both stimuli evoke pain, yet they differ considerably in their physical and perceptual properties. In sensory cortex, cerebral responses to either stimulus should therefore substantially differ. However, given that both stimuli evoke pain, we hypothesized that at a certain subset of cortical regions the different physical properties of the stimuli become less important and are therefore activated by both stimuli. In contrast, regions with clearly dissociable activity may belong to "lower-level" pain processing mechanisms depending on the physical properties of the administered stimuli. We used functional magnetic resonance (fMRI) to intraindividually compare pain-related activation patterns between laser and contact heat stimulation using four different intensities of laser and contact heat stimuli. Common and dissociable neural responses were identified by correlating perceived pain intensities with blood oxygenation level dependent (BOLD) signal changes. Only neuronal responses to stimuli that were perceived as painful were analyzed. Pain-related BOLD signal increases independent of stimulus modality were detected in the anterior insula, anterior cingulate cortex, medial secondary somatosensory cortex, and the prefrontal cortex. These similarities are likely to reflect higher-level pain processing, which is largely independent of the single physical parameters that determine the painful nature of the stimuli.

Clonidine effects on pain evoked SII activity in humans.

We investigated pain evoked activity in the human secondary sensory cortex (SII) following clonidine administration in six healthy volunteers using multi-channel magnetoencephalography (MEG). Pain was elicited by electrical shocks applied intracutaneously to the fingertip. Subjects rated pain intensity and perceptions of tiredness and passiveness by numerical ranking scales. Each subject underwent two investigations, one week apart from each other, with clonidine doses of 1.5 or 3.0microg/kg, administered intravenously in a random order and double-blinded. We applied a total number of seven blocks, each consisting of 60 painful stimuli, with one adaptation block, one pre-medication block, four post-medication blocks and one recovery block at the end of the session. MEG data were analysed by dipole reconstruction using CURRY(R) (Neuroscan, Hamburg) software package. Cortical activity in the contralateral SII cortex appeared with peak latencies of 118.5+/-10ms. This activity was significantly reduced by clonidine, in parallel with a reduction of pain intensity and enhancement of subjective tiredness and passiveness. There was, however, no significant correlation between MEG and subjective effects. Although both clonidine doses had similar effects, the higher dose induced longer changes. Results indicate that intravenous clonidine is able to relieve pain, but the exact mechanism of clonidine at the level of the SII cortex remains unclear. It is possible that clonidine interacts with the brainstem ascending system regulating vigilance and arousal which would explain the observed decrement of pain induced activity in SII. An additional more specific analgesic action at spinal level cannot be excluded.

Evoked potentials during active horizontal head rotations in patients with vertigo.

OBJECTIVES: The purpose of this study was to investigate whether evoked potentials by active head rotation help to verify and topographically differentiate patients with the major symptom vertigo. METHODS: Twenty-four healthy human subjects and 43 patients with either infratentorial or supratentorial brain lesions were analysed. RESULTS: The evoked response in normal subjects was composed of six peaks, indicated by polarization and time difference from the trigger points P100, N30, P0, N50, P155 and N320. The EEG pattern was independent of the direction, type of target and whether the eyes were open or closed. In contrast, the evoked response, especially P155, was dependent on the chosen trigger point and acceleration. P155 was the most stable and significant component of the evoked potentials. Thus, we chose P155 as the reference for studying patients with vertigo. DISCUSSION: In peripheral vestibular disorders, cerebellar and diffuse supratentorial cerebral lesions and P155 latencies remain non-significantly altered. However, P155 latencies significantly increase in pontine lesions homolaterally, and space occupying tumors contralaterally. CONCLUSION: Active horizontal head rotations differentially stimulate the vestibulocortical pathways and may contribute to the analysis of vertigo.

Strategy for the design of custom cDNA microarrays.

DNA microarrays are valuable but expensive tools for expression profiling of cells, tissues, and organs. The design of custom microarrays leads to cost reduction without necessarily compromising their biological value. Here we present a strategy for designing custom cDNA microarrays and constructed a microarray for mouse immunology research (ImmunoChip). The strategy used interrogates expressed sequence tag databases available in the public domain but overcomes many of the problems encountered. Immunologically relevant clusters were selected based on the expression of expressed sequence tags in relevant libraries. Selected clusters were organized in modules, and the best representative clones were identified. When tested, this microarray was found to have minimal clone identity errors or phage contamination and identified molecular signatures of lymphoid cell lines. Our proposed design of custom microarrays avoids probe redundancy, allows the organization of the chip to optimize chip production, and reduces microarray production costs. The strategy described is also useful for the design of oligonucleotide microarrays.