Effect of Ligament Stiffness on Spinal Loads and Muscle

Ligamentsassistmusclesinstabilizingthespinewithinphysiologicalrangesofmotionbylimitingthedisplacements,buttheroleof ligamentsinspinalloadsandmuscleforcedistributionremainsunknown.Thepurposeofthisstudywastoinvestigatetheeffectof differentstiffnessonjointresultantforcesandmuscleforcesindifferentflexedpositions.Forthisstudy,fiveligamentstiffnesssets weredeterminedfromtheliteratureandappliedtoamusculoskeletalspinemodel.Thedimensionsofthemodelwereadjusted accordingtosubjectsintheinvivoexperimentsusedforvalidation,andspinalloadsandmuscleforcesweredeterminedduringflexed positions.Thedifferencesbetweenthespinalloadsduetodifferentligamentstiffnesseswereinsignificant(maximumdifference12%). However,thedifferentligamentstiffnessesshowedastrongeffectonindividualmuscleforces.Amongtheshortmuscles,lumbar multifidiexertedonly65Nwithoutligamentsbuttheforceincreasedupto254Nduetoaddingthemaximumligamentstiffness. However,theloadintheerectorspinaewassignificantlydecreased(30%).Theresultsofthisstudyshowedthatinadditiontolong andsuperficialmuscles,ligamentsalsoplayedanimportantroleinstabilizingthespineinflexedpositions

A Usability Evaluation for the Development of Speech Therapy Solutions for Speech-Impaired People

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Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data

Objective With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs. Methods This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression. Results A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality. Conclusion Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes

Association between the emergency department length of stay and severity-standardized survival among severe emergency patients

Objective: The length of stay in the emergency department (ED) is a major contributor to ED overcrowding, which in turn negatively affects the quality of emergency care. Several efforts have been made to reduce the ED length of stay (EDLOS), including a mandatory target to limit ED-LOS within certain parameters. However, the association between EDLOS and treatment results is yet to be clarified. The authors investigated the influence of ED-LOS on patient survival by comparing severity-adjusted survival. Methods: This study was a retrospective analysis of data registered in 2018 in the National Emergency Department Information System (NEDIS). Cases registered by the regional and local emergency centers were included for analysis. The standardized W scores (Ws) based on the Emergency Department Initial Evaluation Score were used to assess treatment outcomes represented by severity-standardized survival, and the correlation between the Ws and the ED-LOS was analyzed. Results: A total of 2,281,526 cases were included for analysis. The overall mortality comprised 52,284 cases (2.3%) and the median ED-LOS was 165 minutes (interquartile range, 96-301). Although a longer ED-LOS was associated with poorer outcomes overall, the association was not apparent when an analysis of cases eligible for ED-LOS evaluation in the national evaluation program was carried out. Moreover, in the analysis of severe cases with a predicted survival probability of less than 0.9, an ED-LOS shorter than 6 hours was associated with significantly poorer severity-adjusted survival. Conclusion: The study revealed that the current ED-LOS criteria used in the national evaluation program were not associated with better survival

Hypochloraemia is associated with 28-day mortality in patients with septic shock: a retrospective analysis of a multicentre prospective registry

Objectives Hyperchloraemia is associated with poor clinical outcomes in sepsis patients; however, this association is not well studied for hypochloraemia. We investigated the prevalence of chloride imbalance and the association between hypochloraemia and 28-day mortality in ED patients with septic shock. Methods A retrospective analysis of data from 11 multicentre EDs in the Republic of Korea prospectively collected from October 2015 to April 2018 was performed. Initial chloride levels were categorised as hypochloraemia, normochloraemia and hyperchloraemia, according to sodium chloride difference adjusted criteria. The primary outcome was 28-day mortality. A multivariate logistic regression model adjusting for age, sex, comorbidities, acid-base state, sepsis-related organ failure assessment (SOFA) score, lactate and albumin level was used to test the association between the three chloride categories and 28-day mortality. Results Among 2037 enrolled patients, 394 (19.3%), 1582 (77.7%) and 61 (3.0%) patients had hypochloraemia, normochloraemia and hyperchloraemia, respectively. The unadjusted 28-day mortality rate in patients with hypochloraemia was 27.4% (95% CI, 23.1% to 32.1%), which was higher than in patients with normochloraemia (19.7%; 95% CI, 17.8% to 21.8%). Hypochloraemia was associated with an increase in the risk of 28-day mortality (adjusted OR (aOR), 1.36, 95% CI, 1.00 to 1.83) after adjusting for confounders. However, hyperchloraemia was not associated with 28-day mortality (aOR 1.35, 95% CI, 0.82 to 2.24). Conclusion Hypochloraemia was more frequently observed than hyperchloraemia in ED patients with septic shock and it was associated with 28-day mortality