Monitoring changes in thioredoxin and over-oxidised peroxiredoxin in response to exercise in humans

INTRODUCTION

Peroxiredoxin (PRDX) and thioredoxin (TRX) are antioxidant proteins that control cellular signalling and redox balance, although their response to exercise is unknown. This study aimed to assess key aspects of the PRDX-TRX redox cycle in response to three different modes of exercise.

METHODS

Healthy males (n = 10, mean ± SD: 22 ± 3 yrs) undertook three exercise trials on separate days: two steady-state cycling trials at moderate (60% [Formula: see text]O2MAX; 27 min, MOD) and high (80% [Formula: see text]O2MAX; 20 min, HIGH) intensities, and a low-volume high-intensity interval training trial (10 × 1 min 90% [Formula: see text]O2MAX, LV-HIIT). Peripheral blood mononuclear cells were assessed for TRX-1 and over-oxidised PRDX (isoforms I-IV) protein expression before, during, and 30 min following exercise (post + 30). The activities of TRX reductase (TRX-R) and the nuclear factor kappa B (NF-κB) p65 subunit were also assessed.

RESULTS

TRX-1 increased during exercise in all trials (MOD, + 84.5%; HIGH, + 64.1%; LV-HIIT, + 205.7%; p < 05), whereas over-oxidised PRDX increased during HIGH only (MOD, - 28.7%; HIGH, + 202.9%; LV-HIIT, - 22.7%; p < .05). TRX-R and NF-κB p65 activity increased during exercise in all trials, with the greatest response in TRX-R activity seen in HIGH (p < 0.05).

DISCUSSION

All trials stimulated a transient increase in TRX-1 protein expression during exercise. Only HIGH induced a transient over-oxidation of PRDX, alongside the greatest change in TRX-R activity. Future studies are needed to clarify the significance of heightened peroxide exposure during continuous high-intensity exercise and the mechanisms of PRDX-regulatory control.

Multisensory perception and action in 3-ball cascade juggling

Multisensory perception and action in 3-ball cascade juggling was investigated in intermediate-skilled performers by manipulating vision (full or lower field restricted) or ball weight (equal or different). There were main effects for both independent variables but no interactions. Manipulation of ball weight had a more pervasive effect on performance outcome, as well as central tendency and dispersion of kinematic measures of the juggling action. A common finding to both manipulations was that balls were tossed to higher zeniths, thus increasing parabola height and flight time. For intermediate-skilled jugglers, proprioception-haptics available when the balls were in the hands and vision of the balls and hands around the moment of ball toss and catch both make a contribution to the juggling action.

Interception of moving objects while walking in children with spastic hemiparetic cerebral palsy

PURPOSE

The purpose of the study was to examine the coordination of reaching and walking behaviour when children with Spastic Hemiparetic Cerebral Palsy (SHCP) intercept an approaching and hence externally-timed object.

METHOD

Using either the impaired or non-impaired arm, children intercepted a ball approaching from a fixed distance with one of three velocities. Each participant's initial starting position was scaled to their maximum walking velocity determined prior to testing; for the medium ball velocity, participants would arrive at the point of interception at the correct time if they walked with their maximum velocity.

RESULTS

Children with SHCP adapted their reaching and walking behaviour to the different ball approach velocities. These adaptations were exhibited when using the impaired and non-impaired arm, and resulted in similar outcome performance irrespective of which arm was used. Still, children with SHCP found it necessary to increase trunk movement to compensate for the decreased elbow excursion and a decreased peak velocity of the impaired arm.

CONCLUSION

Children with SHCP exhibited specific adaptations to their altered movement capabilities when performing a behaviourally-realistic task. The provision of an external timing constraint appeared to facilitate both reaching and walking movements and hence could represent a useful technique in rehabilitation.

Ecogeographical studies identify diversity and potential gaps in the largest germplasm collection of bladder clover (Trifolium spumosum L.)

Plant germplasm collections are important reservoirs of diversity for plant breeders and adding to the knowledge of the diversity among and within germplasm accessions helps plant breeders to use them more efficiently. The annual legume, bladder clover (Trifolium spumosum L.), was the model plant in this study. The hypothesis that ecogeographical variables are important sources of diversity in the germplasm collection of bladder clover and some variables are more important than others has been studied. Three themes have been addressed here: firstly, analysis of the existing passport data to determine a minimum set of ecogeographical descriptors required for capturing ecological aspects of each collection site; secondly, illustration of the ecogeographical regions and subregions using GIS techniques to identify areas with the greatest likelihood of filling gaps in the collection; thirdly, development of an approach for the evaluation of genetic diversity by grouping accessions with a focus on outliers within the collection using principal component and cluster analyses. In this paper the importance of longitude as a geographical factor has been documented and the overall ecogeographical diversity in the germplasm collection of bladder clover has been screened.

External timing constraints facilitate performance of everyday interceptive actions in children with Spastic Hemiparetic Cerebral Palsy

We examined how children with Spastic Hemiparetic Cerebral Palsy (SHCP) perform interceptive actions they experience in daily life. Children were required to walk towards and intercept a stationary ball or a moving ball, with either their impaired or non-impaired arm. In the stationary ball condition the child was free to determine the speed of their response (internal timing), whereas in the moving ball condition there was a restricted time available (external timing). It was found that the reach movements of the non-impaired arm were different to the impaired arm, and were characterized by some of the typical movement limitations imposed by SHCP. However, there was no evidence of increased contribution from trunk motion or a lengthening of reach movement time or deceleration time. Instead, there was a coordinated change with the walking kinematics, whereby the children spent proportionately more time slowing down as they approached the point of interception when reaching with the impaired arm. There were also several differences in the response when intercepting a moving ball compared to a stationary ball. When the timing constraints were imposed externally (moving ball) rather than internally (stationary ball), children reached with a reduced movement time and deceleration time, and an increased peak wrist velocity and elbow excursion. These adaptations to behaviour were necessary to deal with the restricted time available to make the interception in the moving ball condition compared to when the ball was stationary, and reveal how children with SHCP coordinate walking and reaching when performing natural interceptive actions.

Effects of attentional strategies and anxiety constraints on perceptual-motor organisation of rhythmical arm movements

Effects of anxiety on perceptual-motor organisation of rhythmical forearm movements were examined using an interrupted time series design with staggered baselines. Participants were exposed to repeated baseline sessions interrupted with two anxiety-inducing sessions. Results showed that under moderate levels of anxiety, determined from CSAI-2 and heart rate data, phase relations between oscillating forearms became more stable in in-phase (0 degrees ) and anti-phase (180 degrees ) modes, although these patterns were not maintained in baseline sessions following the anxiety manipulation. Data were consistent with participants employing a strategy of allocating greater attentional effort in stabilizing preferred co-ordination patterns under anxiety-inducing conditions. Results suggest that anxiety can temporarily act as a source of behavioural information, leading to the re-parameterisation of participants' intrinsic dynamics.

The potential for developing fodder plants for the salt-affected areas of southern and eastern Australia: an overview

This paper reviews the major issues that impact upon the development of improved fodder species for saline environments across temperate Australia. It describes past and present research that has been, or is being, undertaken towards improvements in salt tolerance in forage species within Australia in relation to the principal regions where salinity occurs. It includes a discussion on the mechanisms of salt tolerance in plants. An extensive list of known or potential salt-tolerant fodder species is provided and the key opportunities for advancement within each of the 4 major forage groups: grasses, legumes, herbs and shrubs are discussed. Constraints to developing new salt and waterlogging tolerant fodder species are identified. A number of recommendations are made for research that should ensure that Australian producers have access to a new array of productive fodder species suited to saline environments.

Establishment and summer survival of the perennial legumes, Dorycnium hirsutum and D. rectum in Mediterranean environments

The genus Dorycnium has been identified for its potential use as a forage plant for southern Australia, but little is known about factors affecting establishment and survival. This investigation examined some factors affecting the establishment of D. hirsutum and D. rectum in Mediterranean environments of south-west Western Australia. The population dynamics of D. hirsutum and D. rectum seedlings were investigated during the summer drought in 4 environments. The effect of time of sowing on establishment and survival of D. hirsutum was tested as a management option for improving establishment of these species. Poor seedling performance was observed in both Dorycnium species. Less than 20% of D. rectum plants survived the summer drought at all locations, compared with >50% for D. hirsutum seedlings. Poor seedling vigour coupled with weed competition resulted in low plant numbers at 2 sites. Compared with autumn sowings, populations of D. hirsutum sown in August and September had lower plant densities before summer due to poorer seedling emergence. Plant numbers declined during the summer in all plots, but losses were greatest in those sown in September. In both experiments, small D. hirsutum plants survived in plots where little competition was present. Improvements in seedling vigour may be possible with plant breeding but establishment methods that reduce weed competition are valuable. Spring sowing may enable effective weed control before seeding, but later sowings run the risk of reducing seedling emergence and survival.

Salinity mitigation versus weed risks — can conflicts of interest in introducing new plants be resolved?

Southern Australia’s annual-based agricultural system has come at a large cost to the landscape. Dryland salinity is a rapidly expanding environmental problem that is reducing the amount of land available for agriculture, and causing a significant ecological cost to remnant and riparian vegetation. There is an urgent need to increase the area of the landscape that is sown to deep-rooted herbaceous perennials to reduce the increase in dryland salinity, and for their successful adoption by landowners it is recognised that these perennials must be economically viable. Australian perennials are unlikely to provide such options in the short term and therefore there is a need to search for species overseas. Many agricultural weeds have arisen as a direct result of deliberately introduced species escaping cultivation and naturalising in the Australian environment. They cause a huge cost to agriculture in terms of both lost production and control. There is also a cost to natural ecosystems as a result of lost biodiversity and weed management. A conflict of interest thus arises. This paper follows on from a workshop held between the CRC for Plant-based Management of Dryland Salinity and the CRC for Australian Weed Management. It discusses 4 key areas where potential conflict exists between the maintenance of biodiversity in natural ecosystems and the development and introduction of new herbaceous perennials. Each of the issues within pre-entry weed risk assessment, post-entry weed risk assessment, weed risk of translocating native species and field assessments of new species is discussed in detail and suggestions are given on the means to resolve the conflicts. Actions to address the recommendations are urgently required if we are going to resolve the current conflicts of interest between the need for managing present and future environmental weeds and for mitigating dryland salinity.

Local stability in coordinated rhythmic movements: fluctuations and relaxation times

An experiment was conducted to examine the stability of the anti-phase and in-phase modes of coordination by means of both fluctuations and relaxation times. Participants (n=6) performed a rhythmic bimanual forearm coordination task that required them to oscillate their forearms in-phase and anti-phase while grasping two manipulanda at fixed frequencies ranging from 0.6 to 1.8 Hz. Relaxation times were measured as the time taken to return to a stable mode following the application of a transient mechanical torque. It was found that relaxation times were not different statistically across participants, frequencies, and coordinative modes. However, fluctuations, as indicated by the mean S.D. of relative phase across individual frequency plateaus, were significantly greater in the anti-phase than in the in-phase mode of coordination, p<0.05. Whilst providing new empirical support for the notion that relaxation times should be of the same order of magnitude at frequencies outside transition regions, the findings suggest that the level of stochastic noise in the anti-phase mode is greater than that of the in-phase mode. Implications are made for the future assessment of local pattern stability.

Social support and health-related quality of life in chronic heart failure patients

OBJECTIVES

Objectives of this study were to: (1) describe perceived social support during a baseline hospitalization and 12 months later among heart failure patients; (2) examine differences in social support as a function of gender and age (less than 65 and 65 years or older); and (3) examine social support as a predictor of health-related quality of life.

BACKGROUND

Social support is a predictor of well-being and mortality, but little is known about support patterns among heart failure patients and how they influence quality of life.

METHODS

The sample included 227 hospitalized patients with heart failure who completed the Social Support Survey and the Chronic Heart Failure Questionnaire at baseline; 147 patients completed these questionnaires again 12 months after baseline.

RESULTS

Mean baseline and 12-month total support scores were 56 and 53, respectively, with a score of 76 indicating the most positive perceptions of support. The ANOVA indicated significant interactions of gender by age for total (F = 5.04; p = 0.03) and emotional/informational support (F = 4.87; p = 0.03) and for positive social interactions (F = 4.43; p = 0.04), with men under age 65 perceiving less support than men aged 65 and older and women in either age group. Baseline support did not predict 12-month health-related quality of life, but changes in social support significantly predicted changes in health-related quality of life (R2 = 0.14).

CONCLUSIONS

Overall, perceptions of support were moderate to high, but there was wide variation in perceptions over time. Men under age 65 reported less support than other groups of patients. Importantly, changes in social support were significant predictors of changes in health-related quality of life.

Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure

PURPOSE

Because the bioavailability of oral furosemide is erratic and often incomplete, we tested the hypothesis that patients with heart failure who were treated with torsemide, a predictably absorbed diuretic, would have more favorable clinical outcomes than would those treated with furosemide.

PATIENTS AND METHODS

We conducted an open-label trial of 234 patients with chronic heart failure (mean [+/- SD] age, 64 +/- 11 years) from an urban public health care system. Patients received oral torsemide (n = 113) or furosemide (n = 121) for 1 year. The primary endpoint was readmission to the hospital for heart failure. Secondary endpoints included readmission for all cardiovascular causes and for all causes, numbers of hospital days, and health-related quality of life.

RESULTS

Compared with furosemide-treated patients, torsemide-treated patients were less likely to need readmission for heart failure (39 [32%] vs. 19 [17%], P <0.01) or for all cardiovascular causes (71 [59%] vs. 50 [44%], P = 0.03). There was no difference in the rate of admissions for all causes (92 [76%] vs. 80 [71%], P = 0.36). Patients treated with torsemide had significantly fewer hospital days for heart failure (106 vs. 296 days, P = 0.02). Improvements in dyspnea and fatigue scores from baseline were greater among patients treated with torsemide, but the differences were statistically significant only for fatigue scores at months 2, 8, and 12.

CONCLUSIONS

Compared with furosemide-treated patients, torsemide-treated patients were less likely to be readmitted for heart failure and for all cardiovascular causes, and were less fatigued. If our results are confirmed by blinded trials, torsemide may be the preferred loop diuretic for patients with chronic heart failure.

Specificity of task constraints and effects of visual demonstrations and verbal instructions in directing learners' search during skill acquisition

In the present study, the efficacy of visual demonstrations and verbal instructions as instructional constraints on the acquisition of movement coordination was investigated. Fifteen participants performed an aiming task on 100 acquisition and 20 retention trials, under 1 of 3 conditions: a modeling group (MG), a verbally directed group (VDG), and a control group (CG). The MG observed a model intermittently throughout acquisition, whereas the VDG was verbally instructed to use the model's movement pattern. Participants in the CG received neither form of instruction. Kinematic analysis revealed that compared with verbal instructions or no instructions, visual demonstrations significantly improved participants' approximation of the model's coordination pattern. No differences were found in movement outcomes. Coordination data supported the visual perception perspective on observational learning, whereas outcome data suggested that the modeling effect is mainly a function of task constraints, that is, the novelty of a movement pattern.

Effects of manipulating relative and absolute motion information during observational learning of an aiming task

In the visual perception perspective of observational learning, the manipulation of relative and absolute motion information in visual demonstrations optimally directs learners' search towards appropriate task solutions. We assessed the effect of emphasizing transformational information and removal of structural information using point-light kinematic displays in approximating the model's relative motion patterns. Participants viewed computer-simulated point-light demonstrations or normal video demonstrations before and intermittently throughout 100 acquisition trials with knowledge of results on an underarm modified-dart aiming task. On the next day, all participants performed 20 retention trials without demonstrations. The kinematics of spatial and temporal coordination and control variables were examined relative to the model's action, as well as performance scores. The results indicated that approximation of the model's spatial and temporal coordination and control patterns was achieved after observation of either type of demonstrations. No differences were found in movement outcomes. In a second experiment, the effects of manipulating absolute motion information by slow-motion demonstrations were examined relative to real-time demonstrations. Real-time demonstrations led to a closer approximation to the model's spatial and temporal coordination patterns and better outcome scores, contradicting predictions that slow-motion displays convey intact relative motion information. We speculate that the effect of visual demonstration speed on action perception and reproduction is a function of task constraints--that is, novelty or familiarity of relative motion of demonstrated activities.

Multi-segment coordination: fatigue effects

PURPOSE

The aim of this study was to investigate the segmental coordination of vertical jumps under fatigue.

METHODS

Twelve subjects performed maximal countermovement jumps with and without fatigue, which was imposed by maximal continuous jumps in place until their maximal jump height corresponded to 70% of the nonfatigued condition. Video, ground reaction forces, and electromyographic signals were recorded to analyze the segmental coordination of countermovement jumps before (CMJ1) and after (CMJ2) fatigue. The magnitude of joint extension initiation, peak joint angular velocity, and peak net power around the ankle, knee, and hip joints and their respective times were determined.

RESULTS

CMJ2 was characterized by a longer contact time, which was accompanied with an earlier movement initiation and several differences (P < 0.05) in the variables used to describe coordination. When the movement duration was normalized with respect to the contact phase duration, the differences between CMJ1 and CMJ2 were not sustained. A consistent pattern was indicated, in which the segmental coordination did not differ between jump conditions. When the magnitude of the muscle activation was set aside, a remarkably consistent muscle activation time was noticed between conditions.

CONCLUSIONS

It was indicated that countermovement jumps were performed with a consistent well-timed motion of the segments. A "common drive," which acts without the knowledge of the muscle properties, was suggested as mediating and controlling the muscle activation timing between agonist-antagonist muscle pairs.

Reliability and validity of the compliance belief scales among patients with heart failure

BACKGROUND

Lack of medication and dietary compliance leads to troublesome symptoms and hospitalization in patients with heart failure. Compliance behaviors are influenced by beliefs about the behavior.

OBJECTIVE

The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale (BMCS) and the Beliefs about Dietary Compliance Scale (BDCS) among patients with heart failure.

THEORETICAL FRAMEWORK

This study's theoretical framework is the Health Belief Model.

METHODS

A convenience sample of 234 patients with heart failure completed the BMCS and the BDCS. Patients completed the scales at baseline by face-to-face interviews and at 8 and 52 weeks after baseline by telephone interview.

RESULTS

Construct validity of the scales was supported by confirmatory factor analysis. Both the BMCS and the BDCS had benefits and barriers scales with clear factor loadings. The internal consistency reliability estimates of the scales ranged from.63 to.88, with the BMCS having some estimates lower than.70. The test-retest reliability estimates ranged from.07 to.57. The intraclass correlation coefficient estimates were higher between the 8-week and 52-week scores for all scales. Possible reasons for the varying estimates are discussed.

CONCLUSIONS

The BMCS and the BDCS have documented reliability and validity. Future work should be directed at evaluating the responsiveness of the scales to changing patient conditions and testing interventions to improve medication and dietary compliance through changing beliefs.

Discriminating the role of binocular information in the timing of a one-handed catch. The effects of telestereoscopic viewing and ball size

Previous work using prediction-motion tasks has indicated that time-to-contact estimates are based exclusively on binocular information when the approaching object is small. The aim of this study was to examine the influence of object size on the use of binocular information sources in specifying time-to-contact in one-handed catching. Subjects (n = 10) were required to time their grasp to catch different-sized balls (60, 80, and 100 mm in diameter) approaching with a constant spatial trajectory and constant velocity of 2.0 m/s. Binocular information was manipulated with a telestereoscope that increased the individuals' effective interocular separation. Subjects performed six trials with each of the different-sized balls in normal and telestereoscopic viewing conditions. It was found that subjects closed the hand earlier when catching the small and medium balls under telestereoscopic viewing compared with normal viewing; furthermore, that subjects closed their hand earlier for the small and medium balls compared with the large ball under telestereoscopic viewing. With regard to hand aperture, there was an effect of ball size, with the hand being opened to a wider aperture for each increase in ball size. Subjects also opened the hand to a wider aperture when catching the small and medium balls under telestereoscopic viewing. These findings are consistent with the notion of an increased reliance on the use of binocular information when the approaching object is small. Furthermore, they indicate that binocular and monocular sources of information are not used in isolation, but rather in combination to support the timing of one-handed catching.

Antideuteron yield at the AGS and coalescence implications

We present Experiment 864's measurement of invariant antideuteron yields in 11.5A GeV/c Au+Pt collisions. The analysis includes 250x10(6) triggers representing 14x10(9) 10% central interactions sampled for events with high mass candidates. We find (1/2pip(t))d(2)N/dydp(t) = 3.5+/-1.5(stat)+0.9-0.5(syst)x10(-8) GeV-2 c(2) for 1.8<y<2.2, < p(t)> = 0.35 GeV/c ( y(c.m.) = 1.6) and 3.7+/-2.7(stat)+1.4-1.5(syst)x10(-8) GeV-2 c(2) for 1.4<y<1.8, < p(t)> = 0.26 GeV/c, and a coalescence parameter B2; of 4.1+/-2. 9(stat)+2.3-2.4(syst)x10(-3) GeV2 c(-3). Implications for coalescence and antimatter annihilation are discussed.

Mechanical perturbation of the wrist during one-handed catching

In the present study, the co-ordination of grasp and transport components of one-handed catching was examined following mechanical perturbations applied to the wrist. Six skilled catchers (mean age = 27.5 years) performed 64 trials in which tennis balls were projected at approximately 8 ms-1. The trial blocks consisted of 10 non-perturbed trials (NPTs) (baseline), and a block of 54 trials of which 20 trials were perturbed. The perturbation was in the form of a resistive force (12 N) applied via a piece of cord attached to a mechanical brake. In baseline trials participants reached maximal wrist velocity closer to the time of hand-ball contact (237 ms +/- 68) than in the perturbed (309 ms +/- 61) condition. Furthermore the wrist velocity profile of five out of six participants exhibited a double peak immediately after a perturbation. However, aperture variables such as the relative moment of final hand closure (approximately 70% of overall movement time) were not typically affected. The stability of grasp and transport coupling for one-handed catching was shown to vary from trial to trial. Skilled performers exploited redundant degrees of freedom in the motor system when faced with a sudden, unexpected change in task constraints.

Heart Messages: a tailored message intervention for improving heart failure outcomes

Heart failure is a major health problem in the United States leading to high rates of mortality and morbidity and impaired quality of life. Assisting patients to improve compliance with their self-care regimen, including medications, dietary sodium restrictions, and self-monitoring (daily weights, edema assessment), may improve these poor outcomes. This article describes the development and initial evaluation of Heart Messages, a theory-based, tailored message intervention to improve compliance with the self-care regimen recommended for patients with heart failure. The project involved four phases, each of which is described in this article. The Heart Messages tailored message intervention program is available in both printed and Web-based formats. In a pilot study and clinical evaluation project, the program was found to be useful for patient education and feasible for implementation. Larger randomized trials are now warranted to evaluate the effectiveness of the intervention in improving compliance with the self-care regimen and thereby improving outcomes among patients with heart failure.

Self-care strategies for symptom management in patients with chronic heart failure

BACKGROUND

The troublesome symptoms experienced by patients with chronic heart failure are associated with diminished quality of life, frequent hospitalizations, and mortality.

OBJECTIVES

To describe the symptoms experienced by patients with heart failure, to detail the self-care strategies used by these patients in managing their symptoms, and to categorize the self-care strategies.

METHODS

Six focus groups were used with 23 patients who had heart failure, along with six focus groups with 18 family members of the patients. Data analysis was performed by transcription of audiotape recordings of the group sessions and review of field notes.

RESULTS

The patients reported a large number of troublesome symptoms, many consistent with past empirical findings, but some not reported in previous studies. Self-care strategies to manage the symptoms clustered into 11 categories.

CONCLUSIONS

Results from this study provided direction for future studies to (a) identify the prevalence, severity, and etiologies of the commonly reported symptoms, particularly cognitive impairment, loss of balance, and depression; (b) evaluate the emotions reported by women with heart failure; and (c) test the strategies as part of an intervention program to improve symptom management in patients with heart failure.

Urethral diverticula

Urethral diverticula are a common cause of chronic genitourinary symptoms in women. They occur in three percent of women overall with higher frequencies in selected populations of symptomatic women. The peak incidence is between the ages of 25-45 but they affect all ages. The classical presentation is with recurrent urinary tract infections and post micturition dribbling but almost any urinary symptom may be a presenting feature. Reported cure rates following surgery approach 70% for recurrent urinary tract infection and almost 100% for local symptoms such as dyspareunia. However, despite this and the availability of effective diagnostic techniques diagnosis is often delayed. This is partly due to a lack of awareness among clinicians and partly because the condition overlaps the traditional territories of gynaecologists and urologists.

Timing a one-handed catch. II. Adaptation to telestereoscopic viewing

A pre-exposure, exposure, post-exposure design was used to assess the adaptation of the timing of a one-handed catch during telestereoscopic viewing. More specifically, it was examined whether the adaptation involved: (1) ignoring binocular sources of information and selecting other information, or (2) a recalibration of the coupling between the effected binocular information and the catching movement, and (3), if it is recalibration, whether it is restricted to the manipulated binocular information. To test these hypotheses, subjects (n=16) were assigned to one of two groups, each group performing three blocks of 15 trials in the dark with only the ball visible. In the exposure condition, both groups were required to catch balls under binocular telestereoscopic viewing. In the pre-exposure and post-exposure conditions, subjects performed under binocular and monocular viewing, respectively. Kinematics of the grasping movement were recorded. It was predicted that, in the case of a selection process, no after effects would occur in the post-exposure condition, whereas, in the case of recalibration, aftereffects would occur. Moreover, if the recalibration is restricted to the manipulated information, only the group that was provided with binocular vision during the pre- exposure and post-exposure conditions would show aftereffects. Significant condition (pre-exposure, exposure, post-exposure) by block (first three trials, last three trials) effects were found for the moments of grasp onset, peak opening velocity and hand closure, indicating that the hand was opened and closed earlier in the first three trials of telestereoscopic viewing. This coincided with an increase in catching failures. In addition, for the moments of hand closure and peak closing velocity, negative aftereffects were found in the post-exposure condition. The hand was closed later in the first three trials after removal of telestereoscope. With respect to the presence of the aftereffects, no differences were found between the groups. It was concluded that adaptation to telestereoscopic viewing in the timing of a one-handed catch is due to the recalibration of the coupling between information and movement, rather than a selection of another source of information. Moreover, it is likely that the recalibration was not restricted to the single, manipulated information. Rather, the recalibration involves multiple binocular and monocular optical and oculomotor sources of information.

Measurement of dyspnea in patients treated with mechanical ventilation

BACKGROUND: Dyspnea, or difficult breathing, is common in patients receiving mechanical ventilation; however, dyspnea is not routinely or systematically measured. OBJECTIVE: The primary purpose of this methodological study was to evaluate the test-retest reliability of 5 dyspnea rating scales and the criterion validity of 4 dyspnea rating scales in patients receiving mechanical ventilation. The secondary purpose was to examine the correlations between each of these 5 rating scales and physiological measures of respiratory function. METHODS: The convenience sample consisted of 28 patients on mechanical ventilation during their hospitalization in the intensive care units of a large, inner-city hospital. Patients rated their dyspnea twice at 30-minute intervals on the visual analogue scale, the vertical analogue dyspnea scale, the modified Borg scale, the numerical scale, and the faces scale. Test-retest reliability was computed by using the intraclass correlation coefficient. Criterion validity was evaluated by using the Spearman rank-order correlation coefficient. RESULTS: The 5 rating scales had acceptable test-retest reliabilities, with intraclass correlation coefficients ranging from 0.81 to 0.97. Criterion validity of the 4 scales also was acceptable, with Spearman rank-order correlation coefficients from 0.76 to 0.96. The rating scales were not correlated with most of the physiological variables. At least half of the patients reported moderate to severe dyspnea. CONCLUSION: The scales showed acceptable reliability and validity, and they will be useful in quantifying dyspnea experienced by patients receiving mechanical ventilation. Further work is needed to evaluate the extent and the severity of dyspnea in such patients in order to evaluate the effectiveness of interventions.

Measurement of dyspnea in patients treated with mechanical ventilation

BACKGROUND

Dyspnea, or difficult breathing, is common in patients receiving mechanical ventilation; however, dyspnea is not routinely or systematically measured.

OBJECTIVE

The primary purpose of this methodological study was to evaluate the test-retest reliability of 5 dyspnea rating scales and the criterion validity of 4 dyspnea rating scales in patients receiving mechanical ventilation. The secondary purpose was to examine the correlations between each of these 5 rating scales and physiological measures of respiratory function.

METHODS

The convenience sample consisted of 28 patients on mechanical ventilation during their hospitalization in the intensive care units of a large, inner-city hospital. Patients rated their dyspnea twice at 30-minute intervals on the visual analogue scale, the vertical analogue dyspnea scale, the modified Borg scale, the numerical scale, and the faces scale. Test-retest reliability was computed by using the intraclass correlation coefficient. Criterion validity was evaluated by using the Spearman rank-order correlation coefficient.

RESULTS

The 5 rating scales had acceptable test-retest reliabilities, with intraclass correlation coefficients ranging from 0.81 to 0.97. Criterion validity of the 4 scales also was acceptable, with Spearman rank-order correlation coefficients from 0.76 to 0.96. The rating scales were not correlated with most of the physiological variables. At least half of the patients reported moderate to severe dyspnea.

CONCLUSION

The scales showed acceptable reliability and validity, and they will be useful in quantifying dyspnea experienced by patients receiving mechanical ventilation. Further work is needed to evaluate the extent and the severity of dyspnea in such patients in order to evaluate the effectiveness of interventions.

Cost of hospitalizations for heart failure: sodium retention versus other decompensating factors

OBJECTIVE

To determine the cost of heart failure-related hospital admissions and to compare the cost of admissions for sodium retention with the cost of admissions for other decompensating factors.

DESIGN

Retrospective, non-experimental, cost analysis.

SETTING

Midwestern university-affiliated, tertiary care, medical center.

SAMPLE

Two hundred seven heart failure-related admissions, 117 (57%) of which were for sodium retention leading to volume overload.

OUTCOME MEASURES

Cost of hospitalization.

PROCEDURE

Data obtained from the patient and financial records of patients hospitalized for heart failure in 1992 were analyzed using the ratio of cost-to-charge accounting procedure.

RESULTS

The total cost was $2,442,720 for the 207 heart failure-related admissions; the average cost was $12,400 per admission. Approximately half of the cost of the hospitalizations was expended in the 4 cost centers comprising routine and critical care services, which incorporate room charges and nursing care. Another one third of the cost was for supplies, medications, and laboratory tests. Admissions as a result of sodium retention had lower costs than admissions as a result of other factors.

CONCLUSION

The cost of hospitalization for heart failure is high. Routine services, supplies, medications, and laboratory tests used by these patients contribute to the high cost of care. Improved outpatient management strategies are necessary to reduce hospital admissions as a result of sodium retention.

Reforming higher specialist training in the United Kingdom--a step along the continuum of medical education

OBJECTIVES

The requirement to align the arrangements for postgraduate training in the United Kingdom with those elsewhere in the European Community provided the opportunity to review and reform our arrangements for higher specialist training. This paper describes the case for change--the strengths and deficiencies of the traditional pattern of postgraduate medical training, demographic influences in the medical workforce and the need for a more structural or planned approach to training.

CONCLUSIONS

Over the past 5 years substantial progress has been made: the introduction of new regulatory arrangements and a new higher specialist training grade; the development of a managed and flexible system for delivering training to standards set by the Royal Colleges and which can accommodate the needs of those pursuing academic and research medicine; and the opportunity for trainees' progress to be measured against published curricula. The significant programme of change has been underpinned by careful workforce planning and the publication of comprehensive guidance. Significant reform of higher specialist training has been achieved. This paper also makes the case for a more strategic approach to planning and developing medical education across the continuum, from entry to medical school until retirement, which can guide medical education and improve patient care into the next millennium.

Quality of life in women with heart failure

Persons with heart failure (HF) experience impaired quality of life (QOL). However, the majority of research conducted on QOL in persons with HF has been with men. The purpose of this descriptive pilot study was to describe the impact of symptoms of HF and examine the relationships among symptom impact, perceived health status, perceived social support, and overall QOL in 30 women who had recently been hospitalized for HF. The women reported high physical symptom impact, poor perceived physical health status, and impaired QOL. Physical symptom impact, perceived physical health status, and QOL were moderately to highly correlated with one another. Perceived social support was significantly, though not strongly, correlated with physical symptom impact. Emotional symptom impact and mental health status were significantly and negatively correlated with each other but were not significantly correlated with QOL. In this group of 30 chronically ill women, QOL was lower in those women who reported greater physical symptom impact and poorer perceptions of their physical health status.

Characterization of the precipitants of hospitalization for heart failure decompensation

BACKGROUND

The model for management of patients with heart failure may be a key determinant of morbidity and quality of life. Development of a better management strategy for these patients requires determination of the reasons for decompensation that leads to hospitalization.

OBJECTIVES

To ascertain and rank the principal reasons for hospitalization of patients who have heart failure.

METHODS

Retrospective audit of all 1992 admissions (N = 1031; 691 patients) coded for heart failure at a Veterans Affairs medical center and a tertiary care university medical center.

RESULTS

The diagnosis of heart failure was verified by preset criteria in 72% of the patients. Of the 496 patients with documented heart failure, worsening heart failure was a main reason for admission in 390 (79%). Despite different socioeconomic backgrounds, excessive sodium retention was the leading factor (55%) associated with decompensation in patients at both institutions. Other factors precipitated admission much less often.

CONCLUSIONS

Many hospitalizations for heart failure might be avoided by case management directed at lessening sodium overload. Increased use of medications known to be effective in persons with heart failure (angiotensin-converting enzyme inhibitors, digoxin, and adequate diuretic therapy) might reduce the likelihood of decompensation. Implementation of behavioral interventions to assist patients with self-monitoring signs of sodium retention and to improve compliance with medications and dietary sodium restrictions are strategies for further reducing the risk of decompensation.

Characterization of the precipitants of hospitalization for heart failure decompensation

BACKGROUND: The model for management of patients with heart failure may be a key determinant of morbidity and quality of life. Development of a better management strategy for these patients requires determination of the reasons for decompensation that leads to hospitalization. OBJECTIVES: To ascertain and rank the principal reasons for hospitalization of patients who have heart failure. METHODS: Retrospective audit of all 1992 admissions (N = 1031; 691 patients) coded for heart failure at a Veterans Affairs medical center and a tertiary care university medical center. RESULTS: The diagnosis of heart failure was verified by preset criteria in 72% of the patients. Of the 496 patients with documented heart failure, worsening heart failure was a main reason for admission in 390 (79%). Despite different socioeconomic backgrounds, excessive sodium retention was the leading factor (55%) associated with decompensation in patients at both institutions. Other factors precipitated admission much less often. CONCLUSIONS: Many hospitalizations for heart failure might be avoided by case management directed at lessening sodium overload. Increased use of medications known to be effective in persons with heart failure (angiotensin-converting enzyme inhibitors, digoxin, and adequate diuretic therapy) might reduce the likelihood of decompensation. Implementation of behavioral interventions to assist patients with self-monitoring signs of sodium retention and to improve compliance with medications and dietary sodium restrictions are strategies for further reducing the risk of decompensation.

Psychosocial variables and hospitalization in persons with chronic heart failure

Persons with chronic heart failure (HF) must cope not only with the physical impairment of their disease but with the associated emotional distress. The primary purpose of this prospective study was to examine whether the psychosocial variables of symptom impact measured at baseline--health perception, social support and coping--differed between a group of adults with chronic HF who were hospitalized and a group who were not hospitalized during the following six months of the study. A secondary purpose was to examine indices of left ventricular dysfunction that might influence hospitalization. Within the six-month period following baseline data collection, 23 of 62 (37%) patients who completed the study were hospitalized at least once for problems pertaining to HF. Patients in the hospitalized group reported significantly more baseline symptom impact, particularly in the areas of emotional symptoms and deficits of attention and memory. Social support and coping did not differ significantly between hospitalized and nonhospitalized patients. Extent of myocardial dysfunction, age and demographic variables were not significantly different between the two groups. Heart failure decompensation requiring inpatient management was presaged by increased anxiety and disorders of mentation, suggesting that health care providers need to be sensitive to these reported symptoms and their impact, because they might be clues to impending hospitalization.

Beliefs about medication and dietary compliance in people with heart failure: an instrument development study

BACKGROUND

Sodium retention is often a precursor to hospitalization in people with heart failure (HF). Lack of compliance with medications and with dietary sodium restrictions affects sodium retention.

OBJECTIVES

The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale.

METHODS

The Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale are instruments we developed specifically to measure beliefs about compliance with behaviors that affect sodium retention in persons with HF. The scales, based on the Health Belief Model, were designed from a review of literature and from self-reports of people with HF. A convenience sample of 101 people with HF completed the scales.

RESULTS

Internal consistency reliability was satisfactory. Factor analysis provided initial support for construct validity of the scales.

CONCLUSIONS

Future testing of the scales is needed in more diverse populations. The scales can then be used to test interventions tailored to individual subjects' beliefs about compliance.

Development of an instrument to measure threat related to cardiac events

The purpose of this study was to evaluate the reliability and validity of the Cardiac Event Threat Questionnaire (CTQ). The CTQ is a 31-item instrument specific for cardiac events that was developed from a literature review and self-reports of persons who had experienced a recent cardiac event. A convenience sample (N = 270) of persons hospitalized for angina, myocardial infarction, or cardiac surgery completed the CTQ. Satisfactory internal consistency and test-retest reliabilities were found. Results of confirmatory factor analysis and correlation with the Profile of Mood States provide initial support for construct validity of the CTQ.

Relationships among selected antecedent variables and coping effectiveness in postmyocardial infarction patients

Selected theoretical relationships from Lazarus' (1966) model of stress were tested in a convenience sample of 81 postmyocardial infarction clients. Two hypothesized causal models were analyzed. Results from regression analyses indicated 63% of the variance in coping effectiveness was explained by marital status, length of time since hospitalization, perceived availability of social support, uncertainty, degree of threat, coping strategies, and emotions. A revised model that fit the data was proposed. Findings indicated that emotions were an outcome of threat, not coping; threat did not directly affect coping strategies; and coping strategies did not directly influence coping effectiveness.

Complications of transvaginal ultrasound-directed follicle aspiration: a review of 2670 consecutive procedures

PURPOSE

Complications following transvaginal ultrasound-directed follicle aspiration are rare, making it difficult to assess their true incidence. During a 4-year prospective study the complications arising from a series of 2670 consecutive procedures were monitored.

RESULTS

Vaginal hemorrhage occurred in 229 (8.6%) of the cases, with a significant loss (> 100 ml) in 22 (0.8%). Postoperative pelvic infection occurred in 18 (0.6%) of the cases. Hemorrhage from the ovary with hemoperitoneum formation was seen on two occasions and necessitated emergency laparotomy in one instance. A single case of pelvic haematoma formation from a punctured iliac vessel was also recorded; this settled without intervention. Of the 18 cases with infection, 9 were severe with pelvic abscess formation; microbiological examination of the pus from these cases suggests that the most common route of infection in such cases is probably by direct inoculation of vaginal organisms into the peritoneal cavity by the collecting needle.

CONCLUSION

The low incidence of pelvic infection questions the value of using prophylactic antibiotics. No increased risk of infection was demonstrated in cases with preexisting peritoneal damage.