How registered nurses are measuring respiratory rates in adult acute care health settings: An integrative review.

AIMS AND OBJECTIVES: This integrative review aimed to draw conclusions from evidence on how registered nurses are measuring respiratory rates for acute care patients. BACKGROUND: Despite the growing research supporting respiratory rate as an early indicator for clinical deterioration, respiratory rate has consistently been the least frequently measured and accurately documented vital sign. DESIGN: An integrative review. METHODS: A systematic literature search was conducted in June 2022 in four databases: CINAHL, PubMed, Medline and Scopus. Quality appraisal was undertaken using the Joanna Briggs Institute's Checklist. PRISMA guidelines were followed to ensure explicit reporting and reported in the PRISMA checklist. RESULTS: Overall, 9915 records were identified, and 19 met the inclusion criteria. Of these 19 articles, seven themes emerged: estimation and digit preference, lack of understanding and knowledge, not valuing the clinical significance of respiratory rate, oxygen saturation substitute, interobserver agreement, subjective concern and count duration. A high prevalence of bias, estimation and incorrect technique was evident. A total of 15 articles reported specifically on how registered nurses are measuring respiratory rates on general medical and surgical wards. CONCLUSIONS: Despite its importance, this integrative review has determined that respiratory rates are not being assessed correctly by nursing staff in the acute care environment. Evidence of using estimation, value bias or quick count and multiply techniques are emerging themes which urgently require further research. No patient or public contribution.

Characteristics of community-based exercise programs for community-dwelling older adults in rural/regional areas: a scoping review.

Community-based exercise programs for older adults play a potentially important role in mitigating the decline in functional outcomes, body composition, psychosocial outcomes, and cardiovascular health outcomes that commonly occurs with advancing age. There is a limited understanding of the characteristics and effectiveness of community-based exercise programs, particularly when those programs are offered outside metropolitan areas. Rural/regional settings face unique challenges, such as limited access to equipment/resources, transportation, and services, as well as significant costs to run programs. The objective of this scoping review was to characterise studies in the field that have aimed to implement community-based programs in settings identified as rural / regional. A secondary aim was to establish guidance for future exercise programs in this setting and highlight future research directions. A total of 12 studies were conducted in settings identified as rural/regional areas in various countries across the world were included. Of the included studies, five were randomised controlled trials. The majority of included studies reported on functional outcomes (83%) and psychosocial outcomes (75%), yet only 42% reported body composition, 17% reported cardiovascular health and 17% reported dietary outcomes. Low male representation was observed, with women outnumbering men in 7 of 12 studies. There was also minimal investigation of qualitative outcomes in existing community-based exercise programs in rural/regional settings, presenting a key gap for future research to address. Study Protocol: https://osf.io/txpm3/ . Date of registration: 20 July 2020.

Psychological Effects of Whole-Body Vibration Training in Frail Older Adults: An Open, Randomized Control Trial.

The aim of this study was to identify the psychological effects of whole-body vibration (WBV) exercise in frail older adults. About 117 male and female volunteers (82.5 ± 7.9 years) from residential care facilities were randomized and assigned to control, simulated exercise (SIM), or WBV exercise (WBV) groups. All received regular care, while exercise groups also underwent 16 weeks of training (3 × 20 min/week). WBV exercise began with 5 × 1 min bouts (6 Hz/2 mm, 1:1 min exercise:rest), self-progressing to 10 × 1 min (up to 26 Hz/4 mm), and maintaining knee flexion. SIM training mimicked exercise stance and duration. Pre- and post-measures of falls-confidence, quality of life, and functional independence were completed using validated questionnaires. Functional independence and falls-confidence scores increased by 5.8% and 17.4% respectively with WBV exercise, compared with declines in SIM (p = .074/p = .035, respectively) and control (p = .000/p = .000, respectively) participants. Beneficial effects remained for at least 6-month post-intervention. Further WBV benefits were observed in activity, mobility, and self-care elements of quality of life. Sixteen weeks of low-level WBV exercise is sufficient to enhance frail older adults' falls-related confidence, quality of life, and functional independence.

A review of indications and comorbidities in which warfarin may be the preferred oral anticoagulant.

WHAT IS KNOWN AND OBJECTIVE: Direct oral anticoagulants (DOACs) are increasingly prescribed instead of warfarin for chronic anticoagulation for ease of dosing, fewer interactions, and less stringent monitoring. However, it is important to consider indications and comorbidities for which warfarin is still the preferred anticoagulant. This review aims to capture these clinical scenarios in which warfarin may still be preferred over DOACs. METHODS: We undertook a comprehensive literature search using the PubMed database. Key search terms were based on DOAC clinical trial exclusion criteria, as well as indications and conditions in which the use of DOACs for anticoagulation has suggested harm. Society guidelines and tertiary literature were used to inform expert opinion where necessary. Studies were included if they investigated the use of DOACs or warfarin in the identified indications or conditions. RESULTS AND DISCUSSION: Currently, evidence for the use of warfarin over DOACs for anticoagulation is strongest for patients with prosthetic valves, antiphospholipid syndrome, or a high risk of gastrointestinal bleeding. For several clinical situations, including mitral stenosis, obesity, altered gastrointestinal anatomy, pulmonary arterial hypertension, renal or hepatic impairment, and left ventricular thrombus, evidence is lacking but may eventually support the use of DOACs. Depending on indication and condition, appropriateness of DOAC use may vary by agent. WHAT IS NEW AND CONCLUSION: New evidence continues to support new indications and conditions in which DOACs may be appropriate to use for anticoagulation. There are key clinical scenarios, however, in which emerging literature continues to support warfarin as the preferred anticoagulant.

Effects of Whole-Body Vibration Training on the Physical Function of the Frail Elderly: An Open, Randomized Controlled Trial.

OBJECTIVE: To investigate the feasibility and benefits of whole-body vibration (WBV) exercise as a safe and effective training tool for countering sarcopenia and age-related declines in mobility and function in the frail elderly. DESIGN: An open, randomized controlled trial. SETTING: Residential care facilities. PARTICIPANTS: Male and female volunteers (N=117; 82.5±7.9y). INTERVENTIONS: After prescreening for contraindications, participants were randomly allocated to a control, simulated WBV (SIM), or WBV exercise group. All participants received regular care, whereas WBV and SIM participants also underwent thrice-weekly exercise sessions for 16 weeks. Delivered by overload principle, WBV training began with 5 × 1-minute bouts at 6 Hz/2 mm (1:1 min exercise:rest), progressing to 10 × 1 minute at up to 26 Hz/4 mm, maintaining knee flexion. Training for SIM participants mimicked WBV exercise stance and duration only. MAIN OUTCOME MEASURES: The timed Up and Go, Parallel Walk, and 10-m Timed Walk (10mTW) tests performance were assessed, in addition to the Barthel Index Questionnaire, at baseline, 8, and 16 weeks of exercise, and 3, 6, and 12 months postexercise. RESULTS: High levels of compliance were reported in SIM (89%) and WBV training (93%), with ease of use and no adverse effects. In comparison to baseline levels, WBV training elicited clinically important treatment effects in all parameters compared to SIM and control groups. Treatment effects remained apparent up to 12 months postintervention for Parallel Walk Test and 6 months for 10mTW Test. Functional test performance declined during and postintervention in non-WBV groups. CONCLUSIONS: Findings indicate that 16 weeks of low-level WBV exercise provides easily accessible, adequate stimulus for the frail elderly to attain improved levels of physical functionality.

Pretargeted delivery of PEG-coated drug carriers to breast tumors using multivalent, bispecific antibody against polyethylene glycol and HER2.

Pretargeting is an increasingly explored strategy to improve nanoparticle targeting, in which pretargeting molecules that bind both selected epitopes on target cells and nanocarriers are first administered, followed by the drug-loaded nanocarriers. Bispecific antibodies (bsAb) represent a promising class of pretargeting molecules, but how different bsAb formats may impact the efficiency of pretargeting remains poorly understood, in particular Fab valency and Fc receptor (FcR)-binding of bsAb. We found the tetravalent bsAb markedly enhanced PEGylated nanoparticle binding to target HER2+ cells relative to the bivalent bsAb in vitro. Pretargeting with tetravalent bsAb with abrogated FcR binding increased tumor accumulation of PEGylated liposomal doxorubicin (PLD) 3-fold compared to passively targeted PLD alone, and 5-fold vs pretargeting with tetravalent bsAb with normal FcR binding in vivo. Our work demonstrates that multivalency and elimination of FcRn recycling are both important features of pretargeting molecules, and further supports pretargeting as a promising nanoparticle delivery strategy.

Engineering Polymer-Binding Bispecific Antibodies for Enhanced Pretargeted Delivery of Nanoparticles to Mucus-Covered Epithelium.

Mucus represents a major barrier to sustained and targeted drug delivery to mucosal epithelium. Ideal drug carriers should not only rapidly diffuse across mucus, but also bind the epithelium. Unfortunately, ligand-conjugated particles often exhibit poor penetration across mucus. In this work, we explored a two-step "pretargeting" approach through engineering a bispecific antibody that binds both cell-surface ICAM-1 and polyethylene glycol (PEG) on the surface of nanoparticles, thereby effectively decoupling cell targeting from particle design and formulation. When tested in a mucus-coated Caco-2 culture model that mimics the physiological process of mucus clearance, pretargeting increased the amount of PEGylated particles binding to cells by around 2-fold or more compared to either non-targeted or actively targeted PEGylated particles. Pretargeting also markedly enhanced particle retention in mouse intestinal tissues. Our work underscores pretargeting as a promising strategy to improve the delivery of therapeutics to mucosal surfaces.

Global citizenship is key to securing global health: the role of higher education.

Despite growing public awareness, health systems are struggling under the escalating burden of non-communicable diseases. While personal responsibility is crucial, alone it is insufficient. We argue that one must place themselves within the broader/global context to begin to truly understand the health implications of personal choices. Global citizenship competency has become an integral part of the higher education discourse; this discourse can and should be extended to include global health. A global citizen is someone who is (1) aware of global issues, (2) socially responsible, and (3) civically engaged. From this perspective, personal health is not solely an individual, self-serving act; rather, the consequences of our lifestyle choices and behaviors have far-reaching implications. This paper will argue that, through consciously identifying global health within the constructs of global citizenship, institutions of higher education can play an instrumental role in fostering civically engaged students capable of driving social change.

Psychosocial determinants of fruit and vegetable consumption among students in a New Zealand university. Results of focus group interviews.

The '5+ a day' fruit and vegetable servings recommendation was introduced in New Zealand in 1994, but consumption has remained low in young adults ever since. This study aimed to identify psychosocial determinants of fruit and vegetable consumption among New Zealand university students approximately a decade after the guidelines' introduction. Twenty-nine students, aged 18-24 years, took part in focus group interviews. Important determinants included taste and health awareness/knowledge. Flatmates and partners had the greatest social influence. Cost and availability were major barriers to consumption. To improve consumption participants suggested: cooking sessions providing quick/easy recipes; more-varied nutritional information; 'made-to-measure' interventions; increasing awareness of cheap sources of fruit/vegetables; and increasing campus availability of fruit. Determinants including a negative attitude, a lack of self-efficacy and an unawareness of dietary guidelines/health consequences should be considered when developing interventions for this group, whilst a variety of different delivery channels should be used. Participants in the study were not representative of all university students, who generally have a different lifestyle to other young adults and specific determinants for fruit/vegetable consumption. Consequently, additional research is required among other young adults and university students with lower fruit and vegetable intake, so that promotional strategies can be specifically targeted.

Mental Health First Aid training for paramedic students: An evaluation study.

BACKGROUND: The combination of first-year placements, an increasing proportion of mental health callouts, and the high incidence of mental illness in health-professional tertiary students means standard curricula may not adequately prepare early-year paramedic students for mental health challenges. METHODS: A retrospective online survey was used to explore the experiences of paramedic students who have completed Mental Health First Aid (MHFA) training within their undergraduate studies. The content-validated survey explored the relevance, appropriateness, and novelty of MHFA training, and invited participants to reflect on the course strengths and weaknesses. RESULTS: The majority of 102 respondents, predominantly female first- and second-year paramedic students aged 18-24 years, agreed the content was relevant (86%) and appropriate (88%), with 73% agreeing they would recommend to other university students. Thematic analysis identified strengths of the course as perceived increases in mental health literacy and empowerment to act on mental health concerns. A weakness was students perceived the course did not prepare them adequately for clinical practice. CONCLUSION: The inclusion of MHFA early in paramedic curricula is appropriate and relevant, increasing mental health literacy and empowering students to recognise and act upon mental health concerns. Application of practical scenarios may further enhance student learning experiences.

Dietary Inflammatory Index and Associations with Sarcopenia Symptomology in Community-Dwelling Older Adults.

Low-grade systemic inflammation is a key driver of muscle degeneration in older adults, and diets with pro-inflammatory properties may further contribute to loss of muscle mass, strength and function. Therefore, this research aimed to explore the associations between the inflammatory potential of the diet and measures of sarcopenia symptomology in community-dwelling older adults. Upper (handgrip strength, HGS) and lower extremity (sit-to-stand) muscle strength, physical performance (timed-up-and-go, TUG) and appendicular skeletal muscle mass (ASM) was assessed according to the European Working Group on Sarcopenia in Older People version 2 (EWGSOP2) criteria. Multiple 24-hr dietary recalls were used to calculate the Dietary Inflammatory Index (DII), which was then used to group participants into anti- and pro-inflammatory dietary groups. Multiple linear regression investigated associations between DII, muscle strength, physical performance, and muscle quantity adjusted for age, gender, comorbidities, waist circumference and physical activity. Adults 65-85 years (n = 110, 72.1 ± 4.7 years, 76.4% female) were recruited. One participant was identified with sarcopenia, 35.2% were pre-frail, or frail. More participants with a pro-inflammatory DII score had low muscle quantity than those with anti-inflammatory DII (3.4% vs. 6.4%, x2 = 4.537, p = 0.043) and DII was negatively associated with HGS (ß = -0.157, p = 0.016) and ASM (ß = -0.176, p = 0.002) which remained significant after adjusting for covariates. In this population, DII was associated with less favorable muscle strength, physical performance, and muscle quantity.

Physical Activity, Mental Health and Wellbeing of Adults within and during the Easing of COVID-19 Restrictions, in the United Kingdom and New Zealand.

Physical activity (PA) participation was substantially reduced at the start of the COVID-19 pandemic. The purpose of this study was to assess the association between PA, mental health, and wellbeing during and following the easing of COVID-19 restrictions in the United Kingdom (UK) and New Zealand (NZ). In this study, 3363 adults completed online surveys within 2-6 weeks of initial COVID-19 restrictions (April/May 2020) and once restrictions to human movement had been eased. Outcome measures included the International Physical Activity Questionnaire Short-Form, Depression Anxiety and Stress Scale-9 (mental health) and World Health Organisation-5 Wellbeing Index. There were no differences in PA, mental health or wellbeing between timepoints (p > 0.05). Individuals engaging in moderate or high volume of PA had significantly better mental health (-1.1 and -1.7 units, respectively) and wellbeing (11.4 and 18.6 units, respectively) than individuals who engaged in low PA (p < 0.001). Mental health was better once COVID-19 restrictions were eased (p < 0.001). NZ had better mental health and wellbeing than the UK (p < 0.001). Participation in moderate-to-high volumes of PA was associated with better mental health and wellbeing, both during and following periods of COVID-19 containment, compared to participation in low volumes of PA. Where applicable, during the current or future pandemic(s), moderate-to-high volumes of PA should be encouraged.

Physical activity, mental health and well-being of adults during initial COVID-19 containment strategies: A multi-country cross-sectional analysis.

OBJECTIVES: To assess physical activity (PA), mental health and well-being of adults in the United Kingdom (UK), Ireland, New Zealand and Australia during the initial stages of National governments' Coronavirus disease (COVID-19) containment responses. DESIGN: Observational, cross-sectional. METHODS: An online survey was disseminated to adults (n=8,425; 44.5±14.8y) residing in the UK, Ireland, New Zealand and Australia within the first 2-6 weeks of government-mandated COVID-19 restrictions. Main outcome measures included: Stages of Change scale for exercise behaviour change; International Physical Activity Questionnaire (short-form); World Health Organisation-5 Well-being Index; and the Depression Anxiety and Stress Scale-9. RESULTS: Participants who reported a negative change in exercise behaviour from before initial COVID-19 restrictions to during the initial COVID-19 restrictions demonstrated poorer mental health and well-being compared to those demonstrating either a positive-or no change in their exercise behaviour (p<0.001). Whilst women reported more positive changes in exercise behaviour, young people (18-29y) reported more negative changes (both p<0.001). Individuals who had more positive exercise behaviours reported better mental health and well-being (p<0.001). Although there were no differences in PA between countries, individuals in New Zealand reported better mental health and well-being (p<0.001). CONCLUSION: The initial COVID-19 restrictions have differentially impacted upon PA habits of individuals based upon their age and sex, and therefore have important implications for international policy and guideline recommendations. Public health interventions that encourage PA should target specific groups (e.g., men, young adults) who are most vulnerable to the negative effects of physical distancing and/or self-isolation.

'Speaking up for safety': A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis.

BACKGROUND: The international literature highlights patient safety as a critical issue in contemporary health care. Poor interpersonal relationships and ineffective health care team communication are identified as dominant human factors contributing to clinical errors and adverse events. Of concern is that some students appear to lack the skills to speak up for themselves, their patients and others when witnessing unsafe practice on clinical placement. STUDY AIMS: To elicit student and staff perspectives on the quality, effectiveness and appropriateness of an assertiveness-based communication activity prior to clinical placement. DESIGN: The study used a qualitative design. A communication module was offered in the second week of the practice laboratory and involved the use of two graded assertiveness frameworks. SETTING: School of Nursing, Midwifery and Paramedicine, at a regional university in South East Queensland, Australia. PARTICIPANTS: Of the 535 first year undergraduate nursing students enrolled in the laboratory courses, 73 (13.6%) completed an anonymous online survey. Individual interviews were conducted with a university student wellbeing coordinator and student mentor to gain their perspectives of the data. METHODS: An evaluation survey with seven qualitative questions and individual semi-structured interviews were employed. Data was analysed using a thematic approach. RESULTS: Five major themes emerged from the survey data: vicarious learning, establishing boundaries, support in practice, advocacy awareness and practice utility. Three themes emerged from the interviews: empowerment and confidence; support and preparation for advocacy; and authentic learning. CONCLUSIONS: Findings indicate that teaching assertiveness skills and establishing a preparatory framework for 'speaking up for safety' early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success. The activity provided an authentic learning experience with perceived practical application to the workplace and, has the potential to enhance first year curricula by improving communication tools used for students preparing for practice.

Should the governments of 'developed' countries be held responsible for equalizing the indigenous health gap?

Across the globe there is significant variation between and within indigenous populations in terms of world view, culture, and socio-political forces. However, many indigenous groups do share a striking commonality: greater rates of non-communicable diseases and shorter life expectancies than non-indigenous compatriots. Notably, this health gap persists for 'developed' countries, including Australia, Canada, New Zealand and the United States. The question of who is responsible for equalizing the gap is complicated. Using Australia as an exemplar context, this commentary will present arguments 'for' and 'against' the governments of developed nations being held liable for closing the indigenous health gap. We will discuss the history and nature of the health gap, actions needed to 'close the gap', and which party has the necessary resources to do so.

Effects of phosphatidylserine on oxidative stress following intermittent running.

PURPOSE: The aim of the study was to investigate the effects of 750 mg of soybean-derived phosphatidylserine or a glucose polymer placebo, administered daily for 10 d, on markers of oxidative stress, perceived soreness, and muscle damage initiated by intermittent exercise (designed to simulated soccer match play) immediately followed by an exhaustive run. METHODS: Following familiarization, 16 male soccer players completed an exhaustive intermittent exercise protocol on two further occasions (T1 and T2) separated by approximately 14 d. Ten days before T2, the subjects were assigned, in a double-blind manner, to receive either phosphatidylserine (PS) or a placebo (P). Exercise time to exhaustion, sprint performance, ratings of perceived exertion, and HR were recorded throughout both main exercise trials. Venous blood samples were obtained at rest (preexercise), 15 min following exercise (postexercise), 24 h after exercise (post-24 h), and 48 h after exercise (post-48 h). RESULTS: Preexercise and postexercise concentrations of plasma gamma-tocopherol were increased following supplementation in PS, although supplementation had no effect on plasma concentrations of other nonenzymatic antioxidants (vitamin C, alpha-tocopherol, retinol, and beta-carotene). Serum cortisol concentrations, perceived soreness, markers of muscle damage (creatine kinase (CK) and myoglobin (Mb)), and lipid peroxidation (hydroperoxides and conjugated diene lag times) were elevated to an equal extent in PS and P following exhaustive exercise before and following supplementation. The changes in running times to exhaustion from T1 to T2 in PS and P were 4.2 +/- 0.7 and -3.7 +/- 4.2%, respectively (P = 0.084). CONCLUSION: Supplementation with phosphatidylserine was not effective in attenuating the cortisol response, perceived soreness, and markers of muscle damage and lipid peroxidation following exhaustive running; however, supplementation tended to increase running time to exhaustion. Therefore, future research should be undertaken to investigate the potential ergogenic properties of this supplement.

Physiological, psychological and functional changes with whole body vibration exercise in the elderly: FEVER methodology and protocols.

BACKGROUND: The FEVER (Frail Elderly Vibration Exercise Response) study aims to address a paucity of research focusing on the use of Whole Body Vibration (WBV) by frail elderly who, with the highest levels of dependence and fall-related hospitalisation/mortality, potentially stand to benefit most from such accessible exercise. METHODS: FEVER is an open, randomised feasibility study, consisting of multiple parallel arms and a longitudinal element. Rest-home residents aged 70+years will be recruited, and assigned to a WBV-exercise group (WBV), a simulated-WBV-exercise group (SIM), or a control group (CON). WBV- and SIM-participants will undergo thrice-weekly sessions (<20-min each, including 1:1 ratio of exercise:rest) for a 16-week exercise intervention period, whilst CON-participants will receive no intervention beyond normal care. WBV-exercise will start with 5?1-minute sessions (6Hz, 2mm amplitude), progressing to 10?1-minute sessions at which time Hz/amplitude can be increased if desired. During WBV-exercise, participants will maintain an isometric knee flexion of ~20° (±5°), to dampen WBV further up the body. RESULTS: Outcomes will include assessments of functionality (primary outcome), Quality of Life, bone health and cardiovascular function. Measures will be conducted at baseline, 8-weeks and 16-weeks of the intervention, and 3-, 6- and 12-months post-intervention. As a protocol paper, there are no specific results to present; our current purpose is to share the study design with the scientific community. CONCLUSIONS: The FEVER study aims to investigate the beneficial effects of WBV-exercise in the frail elderly, ascertain an effective training regime and for the first-time identify a time-line of detraining.

Reliability of oscillometric central hemodynamic responses to an orthostatic challenge.

BACKGROUND: Monitoring central hemodynamic responses to an orthostatic challenge may provide important insight into autonomic nervous system function. Oscillometric pulse wave analysis devices have recently emerged, presenting clinically viable options for investigating central hemodynamic properties. The purpose of the current study was to determine whether oscillometric pulse wave analysis can be used to reliably (between-day) assess central blood pressure and central pressure augmentation (augmentation index) responses to a 5 min orthostatic challenge (modified tilt-table). METHODS: Twenty healthy adults (26.4 y (SD 5.2), 55% F, 24.7 kg/m(2) (SD 3.8)) were tested on 3 different mornings in the fasted state, separated by a maximum of 7 days. Central hemodynamic variables were assessed on the left arm using an oscillometric device. RESULTS: Repeated measures analysis of variance indicated a significant main effect of the modified tilt-table for all central hemodynamic variables (P < 0.001). In response to the tilt, central diastolic pressure increased by 4.5 mmHg (CI: 2.6, 6.4), central systolic blood pressure increased by 2.3 (CI: 4.4, 0.16) mmHg, and augmentation index decreased by an absolute - 5.3%, (CI: -2.7, -7.9%). The intra-class correlation coefficient values for central diastolic pressure (0.83-0.86), central systolic blood pressure (0.80-0.87) and AIx (0.79-0.82) were above the 0.75 criterion in both the supine and tilted positions, indicating excellent between-day reliability. CONCLUSION: Central hemodynamic responses to an orthostatic challenge can be assessed with acceptable between-day reliability using oscillometric pulse wave analysis.

Multicenter study of the feasibility and safety of using the memotherm carotid arterial stent for extracranial carotid artery stenosis.

OBJECT: Carotid artery (CA) angioplasty with stent placement has been proposed as an alternative technique for revascularization in cases of CA stenosis. In this report the authors review the results of a multicenter Phase I study in which they evaluated the safety and feasibility of using a new self-expanding nitinol stent, the Bard Memotherm, to treat CA stenosis. METHODS: Enrollment was limited to patients in whom there was either 50% or greater symptomatic or 70% or greater asymptomatic stenosis of the internal CA. The primary endpoint was a technically successful implantation procedure (delivery of the stent to the target site and retrieval of the delivery device), resulting in less than 30% residual stenosis demonstrated on immediate postprocedure (control) angiograms, and no incidence of mortality, ipsilateral stroke, Q-wave myocardial infarction, or other major cardiovascular events immediately after or within 30 days following the procedure. Stent placement was attempted for 73 lesions in 71 patients (mean age 71.3 +/- 8.5 years), 43 (61%) of whom were men. The mean degree of stenosis was 82.6 +/- 9%. The stenosis was symptomatic in 27 (37%) and asymptomatic in 46 (63%) of 73 lesions. In four procedures the stent could not be delivered or released. The mean residual stenosis observed on angiograms was 3.8 +/- 6.9% in the 69 lesions treated with the Bard Memotherm stent; residual stenosis was greater than 30% in one of the 69 procedures. The primary endpoint was achieved in 65 (89%) of the 73 procedures. One patient experienced a major ischemic stroke and another patient died of intracerebral hemorrhage. The overall 1-month stroke rate was 2.7% for 73 attempted procedures. One patient died of pneumonia and acute respiratory distress syndrome, which occurred 3 weeks after the stent procedure and was unrelated to the procedure. CONCLUSIONS: The Memotherm stent can be used to treat patients with CA stenosis and is associated with a low peri-procedure complication rate. Long-term follow-up studies are underway to determine the impact of stent placement on the risk of ipsilateral ischemic events.

Effect of whole-body microtitanium-treated garments on metabolic cost of exercise following strenuous hill running.

OBJECTIVES: To determine the effect size of wearing sports garments treated with microscopic titanium particles (AQUA TITAN) during recovery from strenuous running on the restoration of running economy during subsequent exercise. DESIGN: A double-blind crossover was used to determine the effect of AQUA TITAN on running metabolic cost in 10 healthy men. Participants performed 40 min of treadmill running comprising 2×(10 min at 5% and 10 min at -10% grade), followed by random allocation to skin-tight nylon-polyurethane AQUA TITAN treated or non-treated placebo garments covering the torso, limbs, and feet. Garments were worn continuously throughout the next 48-h, during which time participants rested (day 2) then completed a graded treadmill run to determine metabolic outcome (day 3). METHODS: Body-weight normalised running metabolic cost was evaluated by indirect calorimetry and the effect size referenced against the smallest meaningful change in economy (0.9%) for improvement in distance running performance. RESULTS: The fatigue effect while wearing control garments on metabolic cost at 48-h was small (2.2% 95%CL ±1.2%). In contrast, AQUA TITAN garments most certainly reduced running metabolic cost (-3.1% ±0.9%) vs. control. Additionally, AQUA TITAN increased the respiratory exchange ratio (0.011 ±0.005) and lowered minute ventilation at intensities below the ventilatory threshold (-4.0% ±0.9%). CONCLUSIONS: AQUA TITAN garments worn during recovery from strenuous exercise improved subsequent running economy to a magnitude likely to restore endurance performance. Future research should verify the magnitude of garment effects on performance outcomes, and on identifying the acute or passive neural, musculotendinous or metabolic mechanisms responsible.