Loss, resilience and recovery of kelp forests in a region of rapid ocean warming

BACKGROUND AND AIMS

Changes in kelp abundances on regional scales have been highly variable over the past half-century owing to strong effects of local and regional drivers. Here, we assess patterns and dominant environmental variables causing spatial and interspecific variability in kelp persistence and resilience to change in Nova Scotia over the past 40 years.

METHODS

We conducted a survey of macrophyte abundance at 251 sites spanning the Atlantic coast of Nova Scotia from 2019 to 2022. We use this dataset to describe spatial variability in kelp species abundances, compare species occurrences to surveys conducted in 1982 and assess changes in kelp abundance over the past 22 years. We then relate spatial and temporal patterns in abundance and resilience to environmental metrics.

KEY RESULTS

Our results show losses of sea urchins and the cold-tolerant kelp species Alaria esculenta, Saccorhiza dermatodea and Agarum clathratum in Nova Scotia since 1982 in favour of the more warm-tolerant kelps Saccharina latissima and Laminaria digitata. Kelp abundances have increased slightly since 2000, and Saccharina latissima and L. digitata are widely abundant in the region today. The highest kelp cover occurs on wave-exposed shores and at sites where temperatures have remained below thresholds for growth (21 °C) and mortality (23 °C). Moreover, kelp has recovered from turf dominance following losses at some sites during a warm period from 2010 to 2012.

CONCLUSIONS

Our results indicate that dramatic changes in kelp community composition and a loss of sea urchin herbivory as a dominant driver of change in the system have occurred in Nova Scotia over the past 40 years. However, a broad-scale shift to turf-dominance has not occurred, as predicted, and our results suggest that resilience and persistence are still a feature of kelp forests in the region despite rapid warming over the past several decades.

Quasiparticle mass enhancement and temperature dependence of the electronic structure of ferromagnetic SrRuO3 thin films

We report high-resolution angle-resolved photoemission studies of epitaxial thin films of the correlated 4d transition metal oxide ferromagnet SrRuO(3). The Fermi surface in the ferromagnetic state consists of well-defined Landau quasiparticles exhibiting strong coupling to low-energy bosonic modes which contributes to the large effective masses observed by transport and thermodynamic measurements. Upon warming the material through its Curie temperature, we observe a substantial decrease in quasiparticle coherence but negligible changes in the ferromagnetic exchange splitting, suggesting that local moments play an important role in the ferromagnetism in SrRuO(3).

Infrared phonon spectroscopy of a compressively strained (001) SrTiO₃ film grown on a (110) NdGaO₃ substrate

Polarized infrared reflectivity was measured between 5 and 300 K on a 17 nm thick, 1.1% compressively strained epitaxial (001) SrTiO(3) film and the orthorhombic (110) NdGaO(3) substrate upon which it was grown. A strong in-plane infrared anisotropy of the NdGaO(3) substrate was observed and polar modes with B(1u)-and a mixture of B(2u) + B(3u)-symmetry were seen. At low temperatures three new modes arose in the 90-130 cm( - 1) range, which we assigned to 4f Nd electronic transitions. The in-plane SrTiO(3) film phonons showed strong stiffening compared to the phonon frequencies of bulk unstrained SrTiO(3), particularly the soft mode, and the in-plane phonon peaks were found to split. No anomalies were detected as a function of temperature in either the infrared response or lattice parameters of the compressively strained SrTiO(3) film, providing an absence of evidence for the out-of-plane ferroelectric phase transition predicted by theory.

Ferroelectricity in strain-free SrTiO3 thin films

Biaxial strain is known to induce ferroelectricity in thin films of nominally nonferroelectric materials such as SrTiO3. By a direct comparison of the strained and strain-free SrTiO3 films using dielectric, ferroelectric, Raman, nonlinear optical and nanoscale piezoelectric property measurements, we conclude that all SrTiO3 films and bulk crystals are relaxor ferroelectrics, and the role of strain is to stabilize longer-range correlation of preexisting nanopolar regions, likely originating from minute amounts of unintentional Sr deficiency in nominally stoichiometric samples. These findings highlight the sensitive role of stoichiometry when exploring strain and epitaxy-induced electronic phenomena in oxide films, heterostructures, and interfaces.

Standardizing contact investigation protocols

SETTING

The State of Alabama Department of Public Health Division of Tuberculosis Control.

OBJECTIVE

To standardize contact investigation protocols and implement an intervention to increase TB field worker adherence to the protocols with the goal of promoting efficiency and effectiveness in contact investigations.

DESIGN

A process evaluation of existing data collection and management systems and protocols was performed. Standardized protocols and an intervention to increase TB field worker adherence to the protocols were created and pilot tested. These were then implemented and formative evaluation data were collected.

RESULTS

The process evaluation revealed considerable variance among field workers with regard to protocols and definitions of variables related to contact investigations. Protocols were standardized and an intervention targeted at TB field workers was developed. The intervention consisted of a training workshop and the development of a computer-based contact investigation module. This was successfully implemented throughout the state.

CONCLUSIONS

To perform effective contact investigations and conduct studies to improve the effectiveness of these investigations, TB control programs must pay careful attention to precisely defining variables and concepts related to the contact investigation. Furthermore, protocols must be standardized and resources devoted to training of TB field workers to ensure adherence to protocols.

Advance directives in cardiac and pulmonary rehabilitation patients

PURPOSE

Advance directives have been available in parts of the United States for more than 20 years, but research shows that only a small percentage of adults (5-25%) have some form of written advance directive. The purose of this study was to examine the presence of advance directives among persons entering cardiac and pulmonary rehabilitation, and identify characteristics of persons most likely to have advance directives.

METHODS

The sample consisted of 336 cardiac patients and 181 pulmonary patients who enrolled in the University of Alabama at Birmingham's Cardiopulmonary Rehabilitation Program between January 1996 and December 1999. As part of the initial program assessment, patients were asked two questions: (1) Do you have a living will? (2) Do you have any advance directives? For the purposes of this study, the two questions were combined to examine the presence of either a living will or other type of advance directive.

RESULTS

Results indicate that 25% of both subgroups (cardiac and pulmonary patients) report having written advance directives. Logistic regression analysis indicates that among cardiac patients whites and older persons were more likely to have advance directives. Among pulmonary patients, females and whites were more likely to have advance directives.

CONCLUSIONS

These results indicate that only a minority of cardiopulmonary rehabilitation patients have advance directives upon entry into the program, and that the prevalence differs among gender, racial, and age groups. Cardiac and pulmonary rehabilitation programs may be valuable sites for educating patients about advance directives and efforts by rehabilitation personnel may increase the prevalence of advance directives among patients.

An interdisciplinary training program in nutrition sciences and cancer

To address the shortage of health care professionals trained in the nutritional aspects of cancer prevention, the University of Alabama at Birmingham in 1988 initiated the Cancer Prevention and Control Training Program (CPCTP), with R25 grant support from the NIH/NCI. The CPCTP has enrolled 11 predoctoral and 12 postdoctoral trainees, of whom 18 have completed training and five remain in the program. The curriculum and other program elements are described, and the trainees' academic achievements and ultimate careers are reported. The CPCTP has become a significant resource for training cancer nutrition professionals.

Cancer Prevention and Control Training Program at the University of Alabama at Birmingham

The pre- and postdoctoral Cancer Prevention and Control Training Program (CPCTP) at the University of Alabama at Birmingham (UAB) has attracted high-quality trainees from all over the United States. The trainees have pursued courses of study in epidemiology, nutrition sciences, health behavior, environmental health sciences, biostatistics, or public health nutrition; and research projects in cessation of tobacco use, cancer screening, cancer epidemiology, diet modification, nutrient-cancer relationships, statistical modeling of carcinogenesis, medical-nutrition education, and obesity, in precise alignment with NCI cancer control objectives. Both courses and research projects have been interdisciplinary, taking advantage of the strong interdepartmental collaborative atmosphere at UAB. Former trainees have been successfully placed in academic, administrative, and practice positions in which they can strategically apply their cancer prevention and control expertise.

Asthma self-management: do patient education programs always have an impact?

BACKGROUND

During the past 15 years, programs to improve self-management practices in adults with asthma have reported improvement in functional status and reduction of inappropriate use of health care services. However, these programs usually represent an ideal approach, applying multiple patient education methods. Consequently, when these programs are found to be efficacious, it is important to replicate the programs as well as to evaluate less complex methods that may be more appropriate for nonacademic health care settings.

METHODS

We compared the following 3 standardized self-management treatments in a randomized, controlled trial: (1) a replication of the self-management program developed at a university medical center that was previously shown to be efficacious; (2) a modified version of this program including only the core elements; and (3) a usual-care program. Outcome measures included medication and inhaler regimen adherence, asthma symptoms, respiratory illness, functional status, and use of health care resources.

RESULTS

All 3 groups improved on measures of respiratory illnesses, use of health care services, and functional status. Patients in both education groups did no better than the usual-care group.

CONCLUSIONS

The results are inconsistent with the results of the first asthma self-management study at this institution and with those of efficacy studies of similar programs. Two factors, selection of the patient population and historical changes in asthma treatment, most likely contributed to the lack of impact of the self-management programs. As a result of the improved standards for usual care due to both factors, the opportunity to effect patient outcomes was substantially reduced.

The outcome of research training during surgical residency

BACKGROUND/PURPOSE

The exposure to research during residency is currently an integral part of most academic surgical training programs. In this study, graduates of two surgical programs were surveyed to characterize their research experience and to determine the effects on their careers.

METHODS

Between 1975 and 1990, 86 and 61 residents completed general surgical training programs at UCLA Medical Center and at Harbor-UCLA Medical Center, respectively. An anonymous survey was sent to each graduate regarding his research experience and current practice.

RESULTS

Of the graduates who spent 2 years in research, 47% now hold academic positions, compared with 23% for those who spent less than 2 years (P = .18). When the graduates were segregated according to their desire to enter the laboratory, 49% of graduates who requested research time hold academic positions, whereas only 13% of those who would not request research are in academic positions (P = .01).

CONCLUSIONS

Residents who strongly desire a period of research during surgical residency are also more productive in the laboratory. This information should be considered in selecting residents for research training in the current era of academic budget restriction and managed health care.

An inhibitor of the microsomal triglyceride transfer protein inhibits apoB secretion from HepG2 cells

The microsomal triglyceride (TG) transfer protein (MTP) is a heterodimeric lipid transfer protein that catalyzes the transport of triglyceride, cholesteryl ester, and phosphatidylcholine between membranes. Previous studies showing that the proximal cause of abetalipoproteinemia is an absence of MTP indicate that MTP function is required for the assembly of the apolipoprotein B (apoB) containing plasma lipoproteins, i.e., very low density lipoproteins and chylomicrons. However, the precise role of MTP in lipoprotein assembly is not known. In this study, the role of MTP in lipoprotein assembly is investigated using an inhibitor of MTP-mediated lipid transport, 2-[1-(3, 3-diphenylpropyl)-4-piperidinyl]-2,3-dihydro-1H-isoindol-1-o ne (BMS-200150). The similarity of the IC50 for inhibition of bovine MTP-mediated TG transfer (0.6 microM) to the Kd for binding of BMS-200150 to bovine MTP (1.3 microM) strongly supports that the inhibition of TG transfer is the result of a direct effect of the compound on MTP. BMS-200150 also inhibits the transfer of phosphatidylcholine, however to a lesser extent (30% at a concentration that almost completely inhibits TG and cholesteryl ester transfer). When BMS-200150 is added to cultured HepG2 cells, a human liver-derived cell line that secretes apoB containing lipoproteins, it inhibits apoB secretion in a concentration dependent manner. These results support the hypothesis that transport of lipid, and in particular, the transport of neutral lipid by MTP, plays a critical role in the assembly of apoB containing lipoproteins.

Assessing adherence to asthma medication and inhaler regimens: a psychometric analysis of adult self-report scales

Poor adherence to recommended regimens is a substantial problem in the clinical management of adults with asthma and other chronic diseases. Research on adherence assessment is complicated by methodological difficulties including limitations associated with the use of self-report measures. In this study, psychometric techniques were used to analyze two self-report scales for assessing adherence to recommended medication and inhaler use regimens in adults with asthma. Results indicated that the two scales had standard deviations large enough to detect variation adherence, had adequate reliability, and reflected the impact of an intervention designed to improve adherence. The results supported the usefulness of these scales for research on adherence. Additional analyses indicated that the two scales could be combined if the research goal required an overall measure of adherence.

Scale for assessing functional impairment in adults with asthma

Improved outcome measures for asthma research, especially measures of functional status and quality of life, have become increasingly important. This research describes one such measure, the University of Alabama at Birmingham (UAB) Functional Impairment Scale. This scale consists of eight items to assess the impact of asthma on various aspects of daily living. The psychometric properties of the UAB Scale were assessed in two samples. The coefficient alpha reliabilities were high in both samples (.83 and .84), and the item-total correlations indicated all items were measuring the same trait. The score distributions covered the entire range of possible scores, and the central tendencies and dispersions confirmed the presence of enough variation to detect differences in functional impairment among individuals. Correlations between the UAB Scale and other asthma-related measures support construct validity. All of these results support the potential usefulness of the UAB Scale.

Pediatric oncologists' assessment of oncology education in U.S. medical schools: Cancer Education Survey II

The status of cancer education in U.S. medical schools was reassessed in the Cancer Education Survey II, which was initiated in 1989. One thousand and thirty-five cancer educators from 126 of the country's 128 medical schools participated, including 65 pediatric oncologists and 36 family physicians. All agreed that the most important aspects of cancer to teach medical students are early detection and cancer prevention; they considered less important electives in basic science, radiation therapy, and surgical oncology. The 101 pediatric oncologists and family physicians believed that more curriculum time should be devoted to cancer epidemiology, psychosocial aspects, and palliative care. Approximately one third of these 101 physicians also expressed the desire to have more teaching materials available in five general areas: patient education about pediatric cancer, nutrition, epidemiology, palliative care, and continuing care. Lay-language information about pediatric cancer, participation in clinical trials, and current cancer research is still needed.

Use of focus group methodology to develop an asthma self-management program useful for community-based medical practices

Health education programs developed in academic medical centers are not optimally disseminated to community clinical settings. Strategies are needed to translate the findings of research on health education programs into programs useful in a wide range of health care settings. Focus group techniques were used to provide data for revising a successful university-based asthma self-management program to make it more practical for use by community physicians. Physicians representing a variety of specialties attended the sessions and provided feedback on the utility of various components of the original program. The discussions revealed that many physicians felt they did not have the time or resources to conduct the original program and identified elements viewed as impractical. This physician input contributed significantly to the development of a revised program with a briefer, less costly intervention. The revised program was later evaluated by focus group participants. Eighty-eight percent of those who evaluated the revised program agreed they would be able and willing to use the program in their own practices. As a formative evaluation tool, the focus group technique made available useful information that would have been difficult to obtain through evaluation forms alone.

Use of the USMLE to select residents

Many studies have examined the relationships between students' performances on the National Board of Medical Examiners (NBME) Part I and Part II examinations and their postgraduate clinical performances. Most studies have found a positive relationship between students' NBME examination scores and the ratings of residents' clinical performances and/or scores on specialty board certification examinations. Surveys of residency directors have also shown that NBME scores are used as part of the process for selecting residents, although other data and other selection criteria are considered more useful than the NBME scores. One area of continued concern is that a large body of data on the United States Medical Licensing Examination (USMLE) is not yet available. However, the predictive validity of the NBME scores supports the use of USMLE scores as part of the review process to screen potential residents. Residency directors should continue to use a variety of criteria in their final selection decisions and are encouraged to use their own program-specific data to establish and monitor particular cutoff scores for screening applicants.

Biennial survey of physician clinical-nutrition training programs

This is the fourth survey of physician clinical-nutrition training programs. As in previous reports, current fellowship training programs were identified, descriptive information obtained, and program content surveyed. In addition, a questionnaire developed by the American Board of Nutrition Committee on Fellowship Training Programs was used to determine the degree of emphasis given to content in the areas of basic nutrition science, clinical applications, and research training. Among the 38 programs identified, uniform ratings of importance were found in all major topic areas. There was also uniformity in most subtopics, with minor exceptions. As expected, in the area of nutrition in the life cycle, pediatric training programs emphasized infancy and childhood whereas medical-surgical programs emphasized adulthood and aging. Alcoholism was emphasized in medical-surgical training programs whereas cystic fibrosis and inborn errors of metabolism were emphasized in pediatric programs. Nutrition in burn patients received minor emphasis in all programs. The overall uniformity of curricular content in training programs confirms the contention that clinical nutrition has a defined clinical scope and should be considered for establishment as a recognized subspecialty in American medicine.

Features of asthma in older adults

A study compared clinical and functional features of elderly patients with asthma to younger patients at a university medical center. Older patients had a larger than predicted reduction in pulmonary function parameters even though physician-assessed severity, duration of diagnosed asthma, and smoking status were no different between groups. A significant increase in the comorbid diagnosis of chronic obstructive pulmonary disease was noted in older patients with asthma. These two points support the hypothesis that long-standing asthma may lead to irreversible airflow obstruction. Older patients reported better medication compliance and decreases in some respiratory symptoms and demonstrated lower health care utilization.

Nutrition training in graduate medical (residency) education: a survey of selected training programs

Because limited information exists about nutrition training of residents, we studied the teaching practices of nationally recognized nutrition programs. Two hundred thirty-eight nutrition educators and 787 residency-program directors identified 160 institutions with strong nutrition training. The 23 highest-ranked programs were surveyed and 7 were visited. The results showed that 1) clinically active physician-nutritionist role models are the key elements in teaching residents clinical nutrition; 2) multidisciplinary nutrition support teams are valuable learning resources unless they function primarily as technical support services; 3) nutrition elective rotations, although highly effective, are taken by a minority of residents; 4) the nutrition curriculum should include practical learning materials and conferences; and 5) a research environment is important to attract qualified physician-nutritionist role models. A major deficit is teaching nutritionally based approaches to disease prevention in the ambulatory setting. Finally, a shortage of nutrition-oriented physician role models is probably the major constraint in teaching nutrition to residents.

Characteristics and correlates of asthma in a university clinic population

To contribute more comprehensive information about the characteristics of asthma, this article analyzed patients served by the University of Alabama at Birmingham Comprehensive Asthma Program. Their physicians rated one fifth of these patients as having "severe" asthma with the remainder about equally divided between "moderate" and "mild". One in two first received a diagnosis of asthma ten or more years previously. Common comorbidities were hypertension, obesity, rhinitis, bronchitis, sinusitis, and arthritis. One half had visited an emergency room or been hospitalized for asthma in the past year. Inhaled bronchodilators and continuous theophylline were the most commonly prescribed medications. Side effects, especially tachycardia and insomnia, were common and almost exclusively associated with theophylline or corticosteroid therapy. Spirometric assessment showed chronic airflow obstruction in those with more severe asthma. Prevalence of respiratory symptoms, intensity of medication regimen, incidence of side effects, and health care utilization increased as asthma severity increased.

A randomized trial to improve self-management practices of adults with asthma

The prevalence and impact of adult asthma are substantial, and poor self-management practices, especially failures to adhere to treatment regimens, appear to be a significant problem. Desirable characteristics of an intervention program to improve self-management were identified through needs assessment and review of existing patient education resources. A comprehensive program was developed that integrated a workbook with one-to-one counseling and adherence-enhancing strategies. A longitudinal 1-year study compared patients receiving this self-management program with "usual care" patients receiving standard asthma pamphlets. Patients were randomly assigned to conditions. Baseline score and asthma severity were statistically controlled. Self-management patients had substantially better adherence than usual care patients, as well as improved functional status, at follow-up. Hospital and emergency department visits decreased in both groups but did not differ between groups.

Implementing nutrition into the medical curriculum: a user's guide

The medical profession is facing the challenges of the 1990s with a shift to outpatient care and preventive services. Medical schools will need to respond to these forces by reevaluating their curricula and setting new objectives. Nutrition is an essential element in the process of curriculum change. The nutrition educator will be expected to take a leading role in integrating nutrition into the medical school curriculum. This report presents steps and strategies to initiate the process.

Biennial survey of clinical nutrition training programs

Three posttraining program surveys have been done by The American Society for Clinical Nutrition Committee on Subspecialty Training to evaluate the status of training programs in clinical nutrition. This survey updates demographic data about programs and determines which classes are offered or required as a part of basic nutrition-science requirements for nutrition training programs. In addition, the importance of board certification and accreditation of training programs is examined.

Priorities for nutrition content in a medical school curriculum: a national consensus of medical educators

The ASCN Committee on Medical/Dental School and Residency Nutrition Education conducted a series of activities to establish guidelines for nutrition core content in a medical school curriculum. These activities included mail surveys of medical-nutrition educators and a representative group of medical school curriculum administrators and a national consensus workshop of nutrition educators. Results indicated close agreement between the nutrition educators and curriculum administrators (r = 0.89, p less than 0.0001) on the importance ratings of 41 nutrition topics and on the number of hours of nutrition course work that medical schools should provide (44 vs 37 h, respectively, p = 0.14). There was consensus among the nutrition educators that 26 topics should be given priority ratings as essential for inclusion in medical course work. Further prioritization of these topics resulted in a listing of core content topics and subtopics to serve as a guide to administrators and educators for planning nutrition course work in a medical school curriculum.

Evaluation issues in the development of expert systems in medicine

Evaluation of medical decision support software (MDSS)--computer programs to assist health professionals with diagnostic and/or therapeutic decisions--has not kept pace with the development of such programs. This article describes the following formative evaluation issues that must be addressed by developers of MDSS to evaluate these programs properly: (1) How can systematic feedback be obtained about an evolving program? (2) How can enough data to evaluate the program be obtained? (3) How much instruction is necessary? (4) What are the most important aspects for users to evaluate? and (5) How can the appropriate use of a developing MDSS be assured? Data from an ongoing evaluation of an existing MDSS, Quick Medical Reference, are used to illustrate the issues and to suggest recommendations for addressing them.

Subjective symptomatology of asthma in an outpatient population

Characteristics of subjective symptomatology of asthma were examined within a group of 132 adult asthma patients receiving medical care in a university-based, ambulatory clinic setting. Patients responded to 36 symptom descriptions or adjectives associated with asthma which were included in a modified version of the Asthma Symptoms Checklist (ASC). A principal components exploratory factor analysis was conducted and five factors were identified. The five factors measured 1) panic-fear, 2) airways obstruction, 3) hyperventilation, 4) fatigue, and 5) irritability. Psychometric properties of the factor scores were satisfactory. The reliabilities were high, standard deviations were large, and differences in factor mean scores conformed to clinical experience. Correlational analyses support the construct validity of the ASC, especially the panic-fear factor. An important outcome of this study was to verify the ASC factor structure in an outpatient setting. The ASC was confirmed as a valuable instrument for use in self-management programs for adults with asthma. The five ASC factors represent highly stable components of subjective symptomatology of asthma among diverse adult patient populations and geographical settings.

Patient characteristics relevant to effective self-management: scales for assessing attitudes of adults toward asthma

The Asthma Opinion Survey, a 33-item Likert-type instrument, was designed to measure attitudes relevant to self-management in adult outpatients. Items fall into eleven clusters; General Vulnerability, Specific Vulnerability, Attitudes Toward Patient Knowledge, Recognition of Airway Obstruction, Accessibility of Health Care, Panic-Fear, Belief in Treatment Efficacy, Staff-Patient Relationships, Sense of Control, Personal Impact, and Social Impact. Factor analysis of the clusters yielded three factors Vulnerability, Perceived Quality of Care, and Recognition and Control. The items, clusters, and factors all had adequate to good score spreads and internal consistencies. Asthma opinions covaried significantly with demographic characteristics, asthma severity, and intensity of health care utilization, and correlated with the Asthma Symptoms Checklist, an instrument developed at the National Jewish Hospital-National Asthma Center, in ways supporting construct validity. These results suggest the Asthma Opinion Survey is achieving its intended purpose.

Nutrition education for medical students: evaluation of the relative contribution of freshman courses in biochemistry and nutrition to performance on a standardized examination in nutrition

An examination previously developed and used for assessment of nutrition knowledge of medical students in the Southeastern Regional Medical-Nutrition Education Network was used to compare the effectiveness of a basic medical biochemistry course and a 58-hour required nutrition course. The examination was administered to a cohort of freshman students upon entry to medical school, after biochemistry, and then after nutrition. Two other student groups took the examination at the end of the sophomore and senior years, respectively. In the freshman cohort, mean nutrition knowledge scores increased slightly after biochemistry, (52% to 56%), which contained 37 nutrition-related lectures. The mean score of the cohort was 75% after the nutrition course. The sophomores scored 75% and the seniors 73%. These findings suggest 1) basic science courses such as biochemistry cannot be relied upon to add significantly to nutrition knowledge, and 2) a required freshman course can be an effective way to introduce basic and clinical nutrition with good retention of knowledge in subsequent years.

Assessing the use of metered dose inhalers by adults with asthma

The development and analysis of an instrument to evaluate the use of metered dose inhalers by patients in the University of Alabama at Birmingham (UAB) Asthma Program is presented. A total of 238 adult asthma patients demonstrated use of the metered dose inhaler for this analysis. Patient skill in using the inhaler was recorded using the instrument, Inhaler-Use Checklist, developed at UAB. The study found that most patients use metered dose inhalers incorrectly, despite training received from their physicians on proper use of inhalers.

Neuronal activity of the cat supraoptic nucleus is influenced by muscle small-diameter afferent (groups III and IV) receptors

In anesthetized cats, responses of single neurosecretory neurons of the supraoptic nucleus to activation of muscle receptors were investigated. Electrical stimulation (1-3 pulses at 200 Hz) of group III and IV pure muscle afferents (gastrocnemius nerve) evoked excitation of greater than 50% of supraoptic nucleus neurons (n = 50), whereas stimulation of group Ia or Ib fibers was ineffective. Baroreceptor stimulation inhibited 95% of these supraoptic nucleus neurons that responded to activation of muscle afferents. Excitation of receptors in the gastrocnemius muscle by intra-arterial injection of chemicals (NaCl, KCl, and bradykinin) increased firing rates of most (84%, 74%, and 80%, respectively) neurosecretary neurons. The magnitude of the excitatory response was dose dependent--bradykinin being the most effective. The response disappeared after muscle denervation. When the gastrocnemius muscle alone was contracted phasically by ventral root stimulation, discharges of the supraoptic nucleus neurons increased, whereas quick stretch of the muscle had no effect. We conclude that activation of muscle receptors by chemical or mechanical stimulus can directly excite neurosecretory neurons in the supraoptic nucleus and that afferent impulses are carried by polymodal fibers of small diameter but not by the largest afferents (group I) from the muscle. The results may relate to increased concentrations of plasma vasopressin during exercise.

Cross-sectional study of nutrition knowledge and attitudes of medical students at three points in their medical training at 11 southeastern medical schools

Eleven southeastern medical schools cooperated to evaluate nutrition knowledge and attitudes of medical students. This study complements previous reports of an examination of entering freshmen and seniors. Average knowledge scores for 165 students tested after basic sciences (preclinical) training in this study were 67 +/- 7% compared with 53 +/- 6% for freshmen and 69 +/- 8% for seniors. The upperclassmen's scores were higher than the freshmen's (p less than 0.001) and varied with the amount of required nutrition teaching. Only 13% of preclinical students perceived nutrition as important to their careers compared with 74% of entering and 59% of graduating students, suggesting that preclinical teaching reduces their sense of relevance of nutrition to medicine. These findings suggest that nutrition knowledge can be increased through preclinical coursework and that the knowledge level can be maintained through the clinical years. However, the positive attitude of freshmen toward nutrition is lost after preclinical training and is only partially regained after the clinical years.

The history of thought concerning the hypothalamus and its functions

Many initial studies related to identification of the boundaries and structural components, nuclei, tracts and interconnections of the hypothalamus; this continues. Early interest also focused on hypothalamic control of somatic activities and autonomic nervous system functions. During the present century chiefly, interest has developed in the hypothalamus and control of water balance, thirst, water retention and loss (diabetes insipidus and polydipsia). Its role in control of metabolism, body weight (obesity), and the regulation of body temperature has attracted the attention of physiologists for many years. Others have studied hypothalamic regulation of sex and reproductive phenomena. The hypothalamus is now attracting much attention because of its production of neuroendocrine secretions and role in control of the endocrine system. Physiologists realized very early that the hypothalamus is involved in emotional expression, in reaction to stress and adaptive adjustments. Its involvement in disease states and resistance thereto and in determining the nature of behavior has now been recognized as a matter of great importance. The origins of all these interests are reviewed.

A comparison of nutrition knowledge of freshmen and senior medical students: a collaborative study of southeastern medical schools

It has been documented previously that nutrition knowledge of senior medial students at ten southeastern medical schools varies and is positively correlated with student assessment of the quantity and quality of nutrition education. To determine whether the differences in knowledge are related to the medical educational experience or are simply a reflection of differences in the students' knowledge on entry to medical school, the same examination was administered to entering freshmen at eight of the medical schools. The knowledge scores of freshmen were remarkably homogeneous from school to school (53 +/- 1%, range 51-55%), and nutrition knowledge was significantly higher for seniors than for the freshmen at all schools (mean 69 vs 53%, p less than 0.0001). On the basis of responses to survey items on the examination, the freshman medical students were more inclined than senior students to take a nutrition elective (62 vs 34%, p less than 0.0001), and more freshman rated nutrition as being important to their careers (74 vs 59%, p less than 0.05). These data indicate that 1) entering freshman medical students at the different schools studied have comparable levels of nutrition knowledge and are receptive to nutrition education, and 2) differences in medical training programs most likely explain the previously documented variability in nutrition knowledge of graduating medical students. These findings have important implications for professionals planning curricula for medical-nutrition education.

Selection and acquisition of audiovisual materials by health professionals

Audiovisual (AV) materials are widely used in the education of health professionals, and health science educators are usually the people who select audiovisual teaching materials. However, little is known about the selection process and there are few parameters that can be used for guidance. No previous research was uncovered that documented the selection/acquisition of materials by users. This paper reports a survey of health science educators and resource consultants at forty-five academic health centers in the United States, on their experiences in identifying, selecting, and using AV materials. The results provide a baseline of information on which future research can build.

Promoting self-management in adults with asthma: an overview of the UAB program

Most asthma self-management programs have focused on children, but the prevalence and impact, both personal and economic, of adult asthma is substantial. Moreover, failure to adhere to treatment regimens appears to be a significant problem in adult asthma. It appears important, therefore, to develop asthma self-management programs for adults. The UAB program is based on the Health Belief Model for health behavior and on the PRECEDE Model for patient education. A needs assessment and a review of existing educational materials were used to specify the content of a self-care workbook. This workbook seeks to increase cognitive skills, encourage daily self-assessment of asthma, demonstrate success in asthma self-management, and promote effective social support. The overall intervention integrates this workbook with systematic reinforcement of self-monitoring and self-management. A prospective controlled study is comparing patients receiving this "special intervention" with "usual care" patients who receive only routinely available pamphlets providing information about asthma. Patients are randomly assigned to treatments by the closed envelope technique. Sample sizes were determined on the basis of statistical power. Outcomes in five areas are assessed: (1) health care utilization, (2) functional status, (3) knowledge, (4) adherence, and (5) psychological reactions.

Adult Participation in Physical Activities Requiring Moderate to High Levels of Energy Expenditure

In brief: Despite claims that 100 million American adults swim, 75 million bicycle, and 35 million jog, evidence suggests that these figures do not accurately indicate how many exercise on a regular basis. This paper provides interview data on the physical-activity behavior of 15,381 American adults. Projections based on the results of those interviews indicate that during 1984, approximately 77 million adults (almost 53%) participated at least once in moderate to high levels of physical activity, but only about 27 million (18.6%) were active on more than 60 days. The US Department of Health and Human Services has set a goal of having 60% of adults engaging regularly in vigorous forms of activity by 1990. These data should be helpful in providing some notion as to how close we are to this goal.

Leisure time physical activity assessment of American adults through an analysis of time diaries collected in 1981

One of the 1990 Health Objectives established by the U.S. Department of Health and Human Services is for 60 per cent of adults 18-65 years of age to be participating regularly in vigorous physical exercise. Unfortunately, no valid and practical measurement system is available that will allow assessment of leisure time physical activity participation of large populations. Consequently, not only is it difficult to assess progress toward the 1990 goal, an accurate baseline from which to measure potential progress does not exist. This paper presents a time diary technique for measuring aggregate population physical activity participation and utilizes actual time diaries collected from adults by the Institute for Social Research in 1981 to arrive at a possible baseline. The results indicated that time diaries are a viable method for assessing aggregate physical activity behavior of large populations. American Adults were quite sedentary in 1981. Over a period of one week, 31% undertook no leisure time physical activity. Only 14 per cent expended more than 1600 kcals/week in leisure time physical activity, and 10 per cent met the DHHS physical activity requirements.

Nutrition knowledge of senior medical students: a collaborative study of southeastern medical schools

The Southeastern Regional Medical-Nutrition Education Network (SERMEN) comprises 11 medical schools with varied nutrition training programs. A faculty representative from each school rated 41 topics in nutrition as to their importance for medical practice. From the seven topics unanimously chosen, a 90-item examination was prepared using the University of Alabama School of Medicine's Nutrition Test-Item Bank. Thirteen additional items surveyed student attitudes toward their nutrition training. Twenty-one percent of senior students from 10 SERMEN schools took the examination. Results showed significant variation in knowledge levels among the schools on the overall examination and on the seven topics. Eighty-five percent were dissatisfied with the quantity and 60% with the quality of their medical-nutrition education. Knowledge scores correlated with the students' assessments with r values of 0.28 and 0.35, respectively (p less than 0.001). Findings indicate significant variation in nutrition knowledge of US medical students.

A consideration of the ethics of brain death--what are the ethical guidelines for physician, family and society in dealing with brain death?

There is at present considerable confusion with respect to ethical guidelines that should govern the behavior of society and the physician confronted by problems resulting from recent attainments of medicine and science. The use of life supporting devices raises the problem of determining when death has occurred and what is proper ethical procedure in dealing with the deficient half life caused by "Brain Death." Some guidance is obtained from a consideration of the nature of life, the nature of death, the nature of man, and the essence lost in death of man. A parallel consideration of the nature of ethics, the bases of ethics and of ethical decision can be helpful. An individual may have ideals which control behavior, even elevate ethical standards; others entertain concepts that destroy social ethics. Ethics control and direct social interactions; ethics determine the quality of social behavior--ethics are established by societies not by individuals. Numerous commissions have endeavored to define the requirements of physicians for diagnosing brain death and for appropriate subsequent actions. The rationales presented, however, are not invariably accepted by lay society. The problem is created by numerous trends. Among them are the "rightest" movement which, though possessing many virtues, has its excesses such as expressed in the "right to life movement." These have not been beneficial and have necessitated "right to death movements." Opposition is also due to the fact that society's concepts of the medical profession have changed. The practice of organ transplantation has created problems. Finally, the concept of death as other than evil is no longer generally accepted. As more biological manipulations are possible ever more difficult ethical problems will arise. It is a certainty, however, that when brain death has occurred life of man and that of the individual has ended. Although others might not agree, our ethic requires us to use life assist techniques to preserve the vegetative man, the individual who can still breathe spontaneously though lacking consciousness and behavioral ability. All the codes of medical ethics state that a physician shall not kill--this does not mean he cannot permit the terminal phases of death when the essence of human life is lost. A major question is the ethical responsibility of one society toward another. Can an affluent society squander its resources in the preservation of ineffectual life in the body after "brain death" when others are without the medical assistance which would permit total living?

I. P. Pavlov and W. B. Cannon: founders of modern physiological thought relative to behavior and the autonomic nervous system

It was almost a half century ago that I last attended an International Congress in Moscow and Leningrad--the IUPS Congress of 1935. My wife and I traveled far and saw the majesty of this land and its peoples. Here I met the great Pavlov and heard him present his thoughts concerning the conditioning of behavior. Cannon presented his concepts of transmitters and receptors. There were many other famous physiologists present, A. V. Hill and Lord Adrian; Kato of Japan demonstrated single nerve fiber studies. Someone talked of conditioned diuresis; I read a paper on hypothalamic control of the hypophysis. That was the dawn of neuroendocrinology, studies of hypothalamic function, sensory receptors, and the transmitter-receptor era. It was, like now, a time of great scientific endeavor, but there were clouds in the sky--Stalin and Hitler were coming to power, but the U.S.S.R. and America were friends, and in science it is still so. I wonder what some young man here will be able to report 50 years from now.

An innovation in nutrition education: development of a national nutrition test-item bank

A NNTIB prototype has been developed and implemented at the University of Alabama in Birmingham School of Medicine. The further development of the Bank as a shared national resource was considered at a workshop carried out in conjunction with the 1983 ASCN meeting. Through this forum it was confirmed that the concept of a NNTIB is both valid and viable, receiving the support of a variety of nutrition educators and the endorsement of the ASCN Committee on Nutrition Education. The general recommendations of the workshop participants were that a modification of the test-item bank prototype be used as the model for the development of a national bank. A key recommendation was the development of a committee to oversee the acceptance and review of test items included in the NNTIB. Recognizing that the major constraints in the development of a national bank are likely to be logistical, mechanical, and fiscal, it is our belief that each of the limitations could be overcome if the Bank were adopted by a parent society with a long-term commitment to its continued support and development. After such support has been identified and pilot trials have been carried out, the implications of the NNTIB for advances in the field of nutrition go well beyond improved quality of testing materials and extend into the critical area of the establishment of standards of nutrition education and certification of competency. The development of the NNTIB offers a challenge to nutrition educators, national nutrition organizations, and interested governmental agencies for their involvement and support.

The nature of life and the nature of death

Life is defined as a "condition" that distinguishes animals and plants from inorganic materials and dead organisms. Life is comprised of processes and is a maintained state. The most sophisticated form of life is man and our though focuses upon the nature of the life and death of man. Man demonstrates three lives or aspects of life: Life of the body--the physical, life of the mind and life of the spirit. Physical life is basic existence; the mind contributes effectiveness and scope; the spiritual entity contributes maximum living. Physiology: The existence of life physical is demonstrated by the presence of functions. Living tissues and organisms exhibit: Irritability: the ability to be excited or detect stimuli and to respond thereto; Growth and reproduction: this consists of the power of multiplication and duplication, regeneration and differentiation; Adaptability: permitting both change and maintenance of balances (homeostasis); and finally and most characteristic of all is Metabolism: the transformation of energy and the use of materials. These properties, however, can be retained for a while by tissues after death of the organism so there is another mystery of life which we understand only in part. Life consists of structure and processes operating under integrative control. This integrative power is the secret we do not understand--we know it confers all the life properties, the continuous flow of processes related to the organism's need for survival. Death is failure not so much of process but of integrative drive and coordination--but, of course, structure and process can fail too, destroying integrated activity. The total organism is under integrative control by brain and mind, the autonomic nervous system and by the neuroendocrine-endocrine complex, all acting in unison. These physical processes contribute to the existence of the life of the mind and spirit and are in turn powerfully affected by intellect and morale. However, we do not understand the driving force which converts inorganic matter, organizes it and then propels it into life. Life seems to be only a continuation of a heritage--life creating life. Philosophy: The life of the mind requires acquisition of knowledge, curiosity, cultivation of the power to reason, use of thought and contemplation, all under discipline. True life of the mind may not exist and may cease to be even though physical existence may be present. Somewhat the same can be said of the life of the spirit; it also is not automatically genetically granted in completed form.(ABSTRACT TRUNCATED AT 400 WORDS)

Newer concepts of the autonomic system's role derived from reductionist and behavioral studies of various animal species

The evolution of newer concepts, many from old precursors, are elaborated. Among the bases for new thought has been the realization that all body tissues receive autonomic innervation and that this system affects all functions. It is involved in the minutia or reactions studied by their reductionists and in activity of the total organism studied by behaviorists. Newer knowledge suggests that the system's functions can be subdivided into 2 major categories: (1) a role in basic metabolic or vegetative functions. There are 3 realms of such involvement: in energy storage and release; in control of endocrine and neuroendocrine secretions; and in control of exocrine secretion and thus intake, conservation or loss and transformation of energy. The hypothalamus is most highly involved in these autonomic system functions; (2) a role in behavior. The hypothalamus is also highly involved, especially in alerting and defense reactions, concepts relating to Cannon's ideas of emergency function and Selye's concepts of stress. It can be said that the normal, phasic functions of the autonomic system and its involvement in organ and body reactivity are controlled in parallel with the regulation of somatic performances. The several newer interpretative ideas originating from studies of reflexes, reflex patterns and sequences, and of general behavior are the integrative role, the supportive role, the modulatory and finally the anticipatory or determinative role in behavior. The similarity of the role of the autonomic nervous system function in all species, from birds to man, has caught the attention of investigators. This rather than the specializations of the system that are appropriate to the peculiar characteristics of individual species has been emphasized; but species specializations do exist and these should be worthy of future investigation. New concepts of the system's role are evolving from old ideas and new discoveries. Newer concepts of transmitter genesis and tissue receptors are developing that add more detail to our major channels of thought concerning the autonomic system's function. There is a new realization of the system's involvement in pain. Its' directives affect and integrate organ and tissue activity; it determines behavior and expresses the sympathy and judgements of man.