Validating two systems for estimating force and power

This study examined the validity of 2 kinematic systems for estimating force and power during squat jumps. 12 weight-trained males each performed single repetition squat jumps with a 20-kg, 40-kg, 60-kg and 80-kg load on a Kistler portable force plate. A commercial linear position transducer (Gymaware [GYM]) and accelerometer (Myotest® [MYO]) were attached to the bar to assess concentric peak force (PF) and peak power (PP). Across all loads tested, the GYM and MYO estimates of PF and PP were moderately to strongly correlated ( P≤0.05-0.001) with the force plate measurements ( R=0.59-0.87 and R=0.66-0.97), respectively. The mean PF and PP values were not significantly different between the 2 kinematic systems and the force plate, but the estimates did produce some systematic bias and relatively large random errors, especially with the 20-kg load (PF bias >170 N, PF error >335 N, PP bias >400 W, PP error >878 W). Some proportional bias was also identified. In summary, the estimation of PF and PP by a linear position transducer and accelerometer showed moderate to strong relative validity and equivalent absolute validity, but these estimates are limited by the presence of bias and large random errors.

[Regional anesthesia practice in Chile: an online survey]

OBJECTIVE

To conduct a survey to profile the practice of regional anesthesia in Chile and determine the limitations on its use.

MATERIAL AND METHODS

A link to an online questionnaire was sent by e-mail to anesthesiologists who were members of their national professional association (Sociedad Chilena de Anestesiologia). The survey was processed anonymously. Multiple choice items elicited responses concerning general demographic information, professional experience as an anesthetist, academic degree, hospital size, and the use of regional anesthesia in clinical practice (number of procedures and types of techniques). Finally, the questionnaire focused on the use of nerve and plexus blocks.

RESULTS

A total of 209 completed questionnaires were received, for a response rate of 54%. Regional anesthesia was part of routine practice for 97% of the respondents; 68% reported that regional techniques were used in more than 30% of their caseload. Most performed neuraxial techniques: 98.1% were spinal blocks, 96.2% lumbar epidural blocks, and 66.9% thoracic epidural blocks. Routine use of peripheral nerve blockade was reported by 73.7%. Upper limb anesthesia was provided significantly more often than lower limb anesthesia (P =.011). The most common technique involved use of a peripheral nerve stimulator (64%). Skills were mainly acquired through residency programs (68.9%) and self-teaching (20.1%). Peripheral nerve blocks were never performed by 26.3% of the respondents; the reason given most often was lack of training.

CONCLUSIONS

Although regional anesthesia is commonly used in Chile, neuraxial blocks remain the most frequently used types. Peripheral nerve blocks are used fairly often, mostly on an upper limb. Training should stimulate attempts to promote more widespread use of all forms of regional anesthesia.

Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial

PURPOSE

The purpose of this study was to evaluate the effectiveness of integrative health (IH) coaching on psychosocial factors, behavior change, and glycemic control in patients with type 2 diabetes.

METHODS

Fifty-six patients with type 2 diabetes were randomized to either 6 months of IH coaching or usual care (control group). Coaching was conducted by telephone for fourteen 30-minute sessions. Patients were guided in creating an individualized vision of health, and goals were self-chosen to align with personal values. The coaching agenda, discussion topics, and goals were those of the patient, not the provider. Preintervention and postintervention assessments measured medication adherence, exercise frequency, patient engagement, psychosocial variables, and A1C.

RESULTS

Perceived barriers to medication adherence decreased, while patient activation, perceived social support, and benefit finding all increased in the IH coaching group compared with those in the control group. Improvements in the coaching group alone were also observed for self-reported adherence, exercise frequency, stress, and perceived health status. Coaching participants with elevated baseline A1C (>/=7%) significantly reduced their A1C.

CONCLUSIONS

A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs. Fundamentals of IH coaching may be applied by diabetes educators to improve patient self-efficacy, accountability, and clinical outcomes.

Measuring the salivary testosterone and cortisol concentrations of weightlifters using an enzyme-immunoassay kit

This study assessed an enzyme-immunoassay (EIA) kit for measuring the salivary testosterone (T) and cortisol (C) concentrations of weightlifters. Saliva samples (n=64) were collected from male and female weightlifters during normal training procedures and analysed for T and C using a commercial EIA kit and a criterion radioimmunoassay (RIA) method. Significant correlations were demonstrated between the EIA and RIA measurements of salivary T (r=0.72) and C (r=0.96) [corrected] concentrations (P<0.001). Further examination by sample and gender revealed similar relationships. The EIA concentrations of salivary T and C were found to be slightly greater (10-13%) than the RIA values. Similar discrepancies were noted when gender comparisons were made, although the relative information on T (males > females) and C (males=females) were consistent for both assay methods. In conclusion, a commercially available EIA kit provided valid measures of the salivary T and C concentrations of male and female weightlifters. Factors to consider when using an EIA kit include the hormone(s) of interest, the magnitude of the correlations, as well as the descriptive information gained (e. g. absolute, relative) and its uses within sport.

When headaches are not neurological: an unusual presentation of Ebstein's anomaly

A 16-year-old male was admitted following a loss of vision. Baseline observations demonstrated SpO2 80% on air, tachycardia of 180 beats per minute (bpm) and hypotension of 90/50 mmHg. He reported bilateral visual disturbance while sitting in bed together with breathlessness, chest discomfort and dizziness but had not had palpitation or syncope. He had been prescribed propranolol for recurrent migraines of increasing frequency with similar visual disturbances, nausea and vomiting but with no perceived benefit. He was otherwise well, a non-smoker who drank minimally and denied recreational drug use.

On examination, the jugular venous pressure was elevated but there were no other cardiorespiratory findings of note. Arterial blood gas analysis revealed profound hypoxia and a compensated metabolic acidosis. A 12-lead electrocardiogram demonstrated a supraventricular tachycardia with broad QRS (Figure 1). Carotid sinus massage and intravenous adenosine had no effect. Electrolyte levels were abnormal (potassium 2.7 mmol/litre, magnesium 0.45 mmol/litre, corrected calcium 1.60 mmol/litre) and a central venous line was inserted to allow electrolyte replacement. During this procedure, he spontaneously reverted to sinus rhythm at a rate of 70 bpm.

A repeat electrocardiogram showed sinus rhythm with normal axis but T wave inversion in the inferior leads and evidence of pre-excitation with a short PR interval and classical delta waves (Figure 2). As a result, Wolff–Parkinson–White syndrome was diagnosed. The chest radiograph showed an abnormal, globular cardiac silhouette (Figure 3).

Following return to sinus rhythm, the blood pressure and acid–base status normalized. Routine transthoracic echocardiography demonstrated Ebstein's anomaly with an associated atrial septal defect and small membranous ventricular septal defect.

PROMAXX inhaled insulin: safe and efficacious administration with a commercially available dry powder inhaler

OBJECTIVES

We investigated the pharmacokinetic (PK) and pharmacodynamic (PD) properties of recombinant human insulin inhalation powder (RHIIP), manufactured with PROMAXX technology, which allows formation of uniform protein microspheres.

METHODS

Thirty healthy male subjects [age 30 +/- 1 years (mean +/- s.e.), body mass index 24.2 +/- 0.3 kg/m(2)] in a randomized crossover study received 10 IU subcutaneous regular human insulin (SCIns) and 6.5 mg of RHIIP [187 IU, Cyclohaler dry powder inhaler (DPI)] under euglycaemic glucose clamp conditions. Subjects were trained to inhale RHIIP with a flow rate of 90 +/- 30 l/min prior to dosing.

RESULTS

Inhalation of RHIIP was well tolerated with no episode of cough or shortness of breath. RHIIP showed a faster onset of action than SCIns [time to reach 10% of total area under the glucose infusion rate (GIR) curves 73 +/- 2 vs. 95 +/- 3 min, time to maximal metabolic effect (T(max)GIR) 173 +/- 13 vs. 218 +/- 9 min, both p < 0.0001]. Duration of action (371 +/- 11 vs. 366 +/- 7 min) and total metabolic effect (AUCGIR0-10 h 2734 +/- 274 vs. 2482 +/- 155 mg/kg) were comparable. PK results were in accordance with the PD findings. Relative bioavailability (BA) of RHIIP was 12 +/- 2%, and relative biopotency (BP) was 6 +/- 1%.

CONCLUSIONS

PROMAXX technology allowed for safe and efficacious administration of RHIIP to the deep lung with an off-the-shelf DPI. RHIIP showed a fast onset of action and BA/BP comparable to that reported for other inhaled insulin formulations using specifically designed inhalers. Improvements in the insulin delivery technique might allow to optimize drug application in all cases with even higher BA/BP with RHIIP.