Towards more efficient burn care: Identifying factors associated with good quality of life post-burn.

BACKGROUND: As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. METHOD: A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. RESULTS AND DISCUSSION: Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (p<0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. CONCLUSION: For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery.

The criterion-referenced validity of the FITNESSGRAM Trunk-Extension test.

AIM: The purpose of this study was to test utility of different fitness field tests to predict self-reported low-back pain (LBP) in youth. METHODS: A sample of 376 school aged (4th through 10th grade students) first completed a survey instrument designed to assess past events (and degree) of LBP. On subsequent days, participants completed a battery of different muscular fitness tests including the current FITNESSGRAM trunk extension test. Receiver operator characteristic curves (ROC) were used to test the utility of single and combined scores from various tests to predict self-reported LBP. RESULTS: The results show that the trunk extension test used in FITNESSGRAM has poor utility for predicting self-reported LBP. In girls, the sit-and-reach, the static curl-up test, and a composite score using static and dynamic curl-up scores had the highest Area Under the Curve (AUC=0.80, 0.71, and 0.79, respectively). Sensitivity (Se) values ranged from 75.0-85.7 while Specificity (Sp) ranged from 59.1-81.4. In boys, the dynamic curl-up test alone was the best predictor of LBP in high-school boys (AUC=0.75, Sensitivity=75.0 and Specificity=74.1). CONCLUSION: The reasonable Sensitivity values from the ROC analyses indicate that individual and aggregate indicators of musculoskeletal fitness can potentially identify girls that had LBP in the past. However, the low values for Specificity indicates that girls with "No LBP" can be misclassified as being at risk for LBP. The current FITNESSGRAM trunk extension test was not able to discriminate between students with and without LBP therefore, the utility of this test for fitness assessment in youth should be revisited.

K-ras 4A and 4B are co-expressed widely in human tissues, and their ratio is altered in sporadic colorectal cancer.

Ras activating mutations result in constitutive activation of Ras signalling pathways and occur in 30% of human malignancies. K-ras encodes two splice variants, K-ras 4A and 4B, and K-ras activating mutations which jointly affect both isoforms are prevalent in lung, pancreatic and colorectal cancers. Using RT-PCR we examined their expression in normal adult human tissues and addressed whether K-ras splicing is altered in sporadic colorectal cancer by comparing normal colon with colon carcinoma cell lines, and 'matched' tumour and tumour-free colon tissues from the same patient. K-ras 4B was expressed ubiquitously and was the predominant splice variant. K-ras 4A was expressed differentially, with detection in colorectal tumours and cell lines, and normal colon, pancreas and lung--sites where tumours with K-ras activating mutations arise. Both K-ras splice variants were co-expressed by single colon carcinoma cells. The K-ras 4A/4B ratio was significantly reduced in all 6 cell lines examined, including two that lacked K-ras activating mutations, and in 4/9 primary adenocarcinomas. We conclude that K-ras activating mutations do not affect K-ras splicing per se, both isoforms may play a role in neoplastic progression, and altered splicing of either the K-ras proto-oncogene or oncogene, in favour of K-ras 4B, may modulate tumour development.

Ras signaling from plasma membrane and endomembrane microdomains.

Ras proteins are compartmentalized by dynamic interactions with both plasma membrane microdomains and intracellular membranes. The mechanisms underlying Ras compartmentalization involve a series of protein/lipid, lipid/lipid and cytoskeleton interactions, resulting in the generation of discrete microdomains from which Ras operates. Segregation of Ras proteins to these different platforms regulates the formation of Ras signaling complexes and the generation of discrete signal outputs. This temporal and spatial modulation of Ras signal transduction provides a mechanism for the generation of different biological outcomes from different Ras isoforms, as well as flexibility in the signal output from a single activated isoform.

Intra-abdominal pressure and rowing: the effects of inspiring versus expiring during the drive.

BACKGROUND: The lumbar vertebrae of rowers are subjected to high levels of shear and compression at mid-drive, but intra-abdominal pressure (IAP) may partially neutralize these forces. IAP fluctuates with breathing. This study compared the IAP between inspiring during the drive and expiring during the drive. EXPERIMENTAL DESIGN: ten volunteers performed one 5x2-minute repetition test while inspiring during the drive and one 5x2-minute repetition test while expiring during the drive on a rowing ergometer. The five work rates were: 100, 125, 150, 175 and 200 watts at 22, 24, 26, 28 and 30 strokes per minute, respectively. MEASURES: the movement of the body while rowing was analyzed using a position sensor, and IAP was measured using a pressure transducer catheter. RESULTS: A 2x5 repeated measures analysis of variance showed that there was a significant interaction for the dependent variable mid-drive IAP (p<0.05), with the mid-drive IAP increasing at a greater rate while expiring during the drive relative to inspiring during the drive. Across work rate, the mid-drive IAP and minimal IAP were significantly higher while expiring during the drive than inspiring during the drive (p<0.05). Across breathing pattern, the minimal IAP, maximal IAP, average change in IAP and mid-drive IAP increased significantly with work rate (p<0.05). CONCLUSIONS: The data show that expiring during the drive leads to a greater mid-drive IAP than inspiring during the drive.

The impact of new lifting technology in long term care: a pilot study.

1. The researchers conducted a pilot study to test a new lifting system developed with the assistance of nurses. 2. The lift system consists of a portable battery operated power unit that the nurse carries to the bedside and attaches to an overhead track; the ability to share the portable power unit among several track locations is economical. 3. The new lifting system was found to reduce the number of staff necessary to execute patient lifts. This staff saving amounted to 50% of one full time equivalent person per nursing unit. 4. Nurses perceived that less effort was required using the new lifting system compared to a conventional floor model wheeled lifting device.

Physiologic responses to forward and retrograde simulated stair stepping.

This study compared the physiologic responses to forward and retrograde simulated stair stepping on the StairMaster 4000 PT. Twenty male subjects (mean age 23.65 +/- 1.63 years) volunteered for this study. Subjects completed a practice trial of 6 minutes of both forward and retrograde stepping at Level 5. Each experimental trial was divided into four 3-minute stages: Level 3, Level 5, Level 7, and Level 9. Heart rate, blood pressure, and rating of perceived exertion (RPE) were recorded during the second minute of each stage. Expired gases were analyzed and averaged over the last 2 minutes of each stage. Caloric expenditure and delta efficiency were later calculated. Data were analyzed using a 2 x 4 ANOVA (direction by level) and 2 x 3 ANOVA (for delta efficiency). Compared to forward responses, retrograde heart rates were significantly higher at Levels 7 and 9 (p < 0.01). Retrograde responses for RPE, metabolic equivalents (METS), and caloric expenditure were significantly higher at (p < 0.01) Levels 5, 7, and 9 when compared to forward responses. However, the results of this study show that these differences between forward and retrograde stepping are not practically meaningful.

The reliability and validity of the 20-meter shuttle test in American students 12 to 15 years old.

The purpose of this study was threefold: to determine (a) the test-retest reliability of the 20-m shuttle test (20 MST) (number of laps), (b) the concurrent validity of the 20 MST (number of laps), and (c) the validity of the prediction equation for VO2max developed by Léger, Mercier, Gadoury, and Lambert (1988) on Canadian children for use with American children 12-15 years old. An intraclass coefficient of .93 was obtained on 20 students (12 males; R = .91 and 8 females; R = .87) who completed the test twice, 1 week apart (MT1 = 47.80 +/- 20.29 vs. MT2 = 50.55 +/- 22.39 laps; p > or = .13). VO2peak was obtained by a treadmill test to volitional fatigue on 48 subjects. The number of laps run correlated significantly with VO2peak in males (n = 22; r = .65; F [1, 20] = 14.30 p < or = .001), females (n = 26; r = .51; F [1, 24] = 8.34; p < or = .01), and males and females = (r = .69; F [1, 46] = 42.54, p < or = .001). When the measured VO2peak (M = 49.97 +/- 7.59 ml.kg-1.min-1) was compared with the estimated VO2max (M = 48.72 +/- 5.72 ml.kg-1.min-1) predicted from age and maximal speed of the 20 MST (Léger et al., 1988) no significant difference was found, t (47) = -1.631; p > or = .11, between the means; the r was .72 and SEE was 5.26 ml.kg-1.min-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of swimming and land exercises versus swimming and water exercises on body composition of college students.

The purpose of this study was to examine the effects of 2 different swimming and calisthenic exercise programs on body composition and swim performance. Subjects were forty-two students (M = 19; F = 23; mean age = 20.8 yr). The experimental groups (Swim-Land [SL], n = 14; Swim-Water, [SW], n = 16) participated in 35-40 min exercise sessions which consisted of a 5-10 min warm-up, 15-20 min of swimming, and 10-15 min of calisthenics three times per week for 8 weeks. The SL experimental group performed calisthenics on land with surgical tubing while the SW experimental group performed comparable calisthenics in the water. Subjects were pretested and posttested utilizing hydrostatic weighing to determine body density and calculate percent fat. Skinfold measures and the 12-min swim for distance were also measured. Results indicated a significant 20% increase in swim performance in both experimental groups (SL = 455 +/- 144 m to 553 +/- 114 m; SW = 465 +/- 122 m to 556 +/- 123 m; p less than 0.05) but no difference between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Body composition and sexual maturation in premenarcheal athletes and nonathletes.

The purpose of this study was to compare premenarcheal athletes (A) and nonathletes (NA) in terms of body composition and sexual maturation and to discern the relationship between these variables. Percent body fat (%BF) was determined by the three-component system of Siri utilizing body density from hydrostatic weighing and total body water measured by deuterium oxide dilution. Sexual maturation was self-assessed using the system described by Marshall and Tanner. ANOVAs and polynomial regression analysis revealed that both the A (N = 73) and NA (N = 53) showed similar values and linear increases (P less than 0.001) in height (HT), weight (WT), breast (B) and pubic hair (PH) development from 7 to 15 yr but not in %BF (XA = 15.7 +/- 4.6; XNA = 20.5 +/- 6.4 (P less than 0.001]. The NA exhibited a quadratic curve (P less than 0.01) in %BF over age, while the A showed a negative linear relationship (P less than 0.001) with age. Scheffe post hoc tests revealed significant differences (P less than 0.03, A less than NA) at 11 and 12-15 yr. When %BF was compared to maturation, the A were found to have less fat (P less than 0.01) at stages 1 and 4 of PH and at stages 2, 3, and 4 of B. There were no significant differences between A and NA in the age at which B2, 3, or 4 or PH2, 3, or 4 occurred. Both groups exhibited similar and significant correlations between age, HT, WT, B, and PH development but not %BF.(ABSTRACT TRUNCATED AT 250 WORDS)

Separate and sequential effects of exercise and meal ingestion on energy expenditure.

The present study was undertaken to determine whether or not untrained, non-obese college-aged females (n = 10) would exhibit a greater thermic response when exercise (E) (treadmill walking at 56% VO2max) preceded a meal (F) [3,846 kJ (920 kcal), 60% carbohydrate, 25% fat, and 15% protein] (EF) compared with exercise only (ENF) or a meal alone (NEF). A protocol in which neither exercise nor food (NENF) was present served as a baseline. Energy expenditure during 60 min of recovery increased 21.5% for the NEF condition, did not change in the ENF condition, and increased 20% in the EF condition over the corresponding resting metabolic rate. It was concluded that there was no interactive thermic effect from the exercise food sequence above the thermic effect of the meal alone.

Passing rates of American children and youth on the FITNESSGRAM criterion-referenced physical fitness standards.

The purpose of this study was twofold: (1) to determine the percentage of 6-18-year-old students who passed the FITNESSGRAM criterion scores for percent body fat (%BF), body mass index (BMI), mile run (MR), sit-ups (SU), pull-ups (PU), and sit and reach (S&R), and (2) to suggest and illustrate the instructed-uninstructed/mastery-nonmastery technique for the validation of criterion-referenced cut-off scores. The data base consisted of the NCYFS I and II national probability samples of students. Results showed that the most frequently passed item was the S&R (M = 90%; F = 97%), followed by the two body composition items (%BF: M = 89%; F = 91%) (BMI: M = 88%; F = 85%), the MR (M = 77%; F = 60%), SU (M = 65%, F = 57%), and finally the PU (M = 73%; F = 32%). It is recommended that the criterion cut-off scores be statistically validated using the illustrated technique when the active (instructed) group has been trained with documented levels of frequency, intensity, and duration and the inactive (uninstructed) group is truly sedentary.

Development of placement tests for firefighting: a long-term analysis by race and sex.

This study summarises 16 years of data on simulated firefighting tasks used to select firefighters in the City of Chicago, Illinois. Four issues related to firefighter applicant testing are analysed: (1) test reliability; (2) test specificity; (3) racial/ethnic aspects of performance; and (4) sex-related aspects of performance. The findings indicated that the tests were moderately reliable but considerable day-to-day improvement was observed particularly among females. With respect to test specificity, simulated firefighter tasks do not appear to be highly correlated to traditional physical performance tests. Little difference was observed between the black, white and hispanic subjects tested. There were large differences between males and females on the physical performance tests and this difference appeared to be, in part, due to differences in size and body composition between sexes. This finding was consistent with other studies.

Somatotypes of premenarcheal athletes and non-athletes.

One-hundred thirty-four premenarcheal girls between the ages of 7 and 15 years were somatotyped according to the Health-Carter technique. Sexual maturation was determined by self-assessed Tanner stages. Statistical analysis was completed on 50 athletes (representing seven sports) and 29 non-athletes over the age of 10 years. The mean somatotype for the athletes was calculated to be 2.4-3.6-3.9 and for the non-athletes 3.7-3.7-3.6. Single component ANOVA's revealed that the athletes were significantly less endomorphic (p less than 0.01) than the non-athletes. The overall somatotype ratings and the equality of dispersion about the means were significantly different between the athletes and non-athletes. The single highest category for the athletes was mesomorph-ectomorph and for the non-athletes, mesomorphic-endomorph. Significant negative correlations were obtained between mesomorphy and breast development (-0.33, p less than 0.05) and mesomorphy and pubic hair development (-0.44, p less than 0.01) for the athletes. Significant positive correlations were obtained between endomorphy and breast development (0.55, p less than 0.01) and endomorphy and pubic hair development (0.45, p less than 0.05) for the non-athletes. The mean somatotype for the gymnasts was 2.1-3.9-3.6 and for the swimmers 2.5-3.4-4.1. These two groups were significantly different from each other on each separate component and overall somatotype, but not in equality of dispersion. The results support the conclusion that premenarcheal athletes are morphologically different from non-athletes despite their youth and from each other based on sport specificity.

Exercise during gravity inversion: acute and chronic effects.

The purpose of this study was to determine whether gravity inversion could correctly be called an exercise, and whether inversion and inverted exercise produced safe blood pressure responses. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen consumption (VO2) were measured in 19 healthy young men (means = 20.31 years) in seven positions: (1) standing passive (STD), (2) inverted passive (INV), (3) standing recovery postpassive inversion (SRPI), (4) standing exercise (SDE), (5) standing recovery poststanding exercise (SRPSE), (6) inverted exercise (INVE), and (7) inverted recovery postinverted exercise (IRPIE). Ten of the subjects participated in a five-week inversion training program, after which all 19 subjects were retested. Compared to STD, INV elicited significant increases in SBP/DBP and a significant decrease in HR. The average INV blood pressure was 146/97 mmHg, which was further increased during INVE to 158/101 mmHg. These responses increase the workload of the heart and may be dangerous to some populations. No physiologic adaptations occurred in any of the inverted positions as a result of inversion training. Gravity inversion should not be compared to or classified as an exercise. Some previously suggested inverted exercises are not recommended. Because of the nature of the responses, medical screening before the use of inversion devices is critical.