The drinking water crises of Flint and Havelock North: a failure of public health risk management.

Between 2014 and 2016, there were two severe community water system (CWS) failures in Flint, Michigan (MI), USA and Havelock North, Hawkes Bay, New Zealand. These events had profound implications for public health in their respective countries. While the nature of both crises was different, certain aspects of the failings were strikingly similar. These included: failure of authorities to protect the integrity of their source water, 'wait-and-see approach' to address problems if and when they occurred, negligent approach to regulatory oversight and responsibility, substandard facilities and lack of knowledge and training of staff, failure of consultants and advisory services engaged by suppliers, and failure of government agencies to enforce regulations. The lessons from both incidents must be learned, or similar tragic events are likely to reoccur. The six principles identified in the Government Inquiry into the Havelock North outbreak are an essential first step. The next step is to implement them throughout the drinking water sector.

The effect of acute exercise on undercarboxylated osteocalcin in obese men.

SUMMARY: The purpose of this study was to examine if the reduction in glucose post-exercise is mediated by undercarboxylated osteocalcin (unOC). Obese men were randomly assigned to do aerobic or power exercises. The change in unOC levels was correlated with the change in glucose levels post-exercise. The reduction in glucose post-acute exercise may be partly related to increased unOC. INTRODUCTION: Osteocalcin (OC) in its undercarboxylated (unOC) form may contribute to the regulation of glucose homeostasis. As exercise reduces serum glucose and improves insulin sensitivity in obese individuals and individuals with type 2 diabetes (T2DM), we hypothesised that this benefit was partly mediated by unOC. METHODS: Twenty-eight middle-aged (52.4 ± 1.2 years, mean ± SEM), obese (BMI = 32.1 ± 0.9 kg m(-2)) men were randomly assigned to do either 45 min of aerobic (cycling at 75% of VO(2peak)) or power (leg press at 75% of one repetition maximum plus jumping sequence) exercises. Blood samples were taken at baseline and up to 2 h post-exercise. RESULTS: At baseline, unOC was negatively correlated with glucose levels (r = -0.53, p = 0.003) and glycosylated haemoglobin (HbA1c) (r = -0.37, p = 0.035). Both aerobic and power exercises reduced serum glucose (from 7.4 ± 1.2 to 5.1 ± 0.5 mmol L(-1), p = 0.01 and 8.5 ± 1.2 to 6.0 ± 0.6 mmol L(-1), p = 0.01, respectively). Aerobic exercise significantly increased OC, unOC and high-molecular-weight adiponectin, while power exercise had a limited effect on OC and unOC. Overall, those with higher baseline glucose and HbA1c had greater reductions in glucose levels after exercise (r = -0.46, p = 0.013 and r = -0.43, p = 0.019, respectively). In a sub-group of obese people with T2DM, the percentage change in unOC levels was correlated with the percentage change in glucose levels post-exercise (r = -0.51, p = 0.038). CONCLUSIONS: This study reports that the reduction in serum glucose post-acute exercise (especially aerobic exercise) may be partly related to increased unOC.

Oxygen (O2) kinetics during early recovery from peak exercise in patients with Type 2 diabetes.

AIMS: To examine the oxygen (O(2)) kinetics during early recovery from peak exercise in patients with Type 2 diabetes and to examine whether oxygen O(2) recovery is associated with fasting glucose and HbA(1c) in this population. METHODS: Eighty-nine participants (52 men) aged 51.8 ± 7.1 years (mean ± SD) were divided into three groups: normal weight (BMI ≤ 25.0 kg/m(2)), overweight/obese without diabetes (BMI ≥ 26 kg/m(2)) and overweight/obese with Type 2 diabetes. Participants were assessed for their aerobic power (VO(2peak)) on a cycle ergometer, provided a fasting blood sample and underwent a series of anthropometric measurements. Early recovery period was measured for 60 s from cessation of exercise and expressed as percentage of VO(2peak) (higher percentage represents slower recovery). RESULTS: No significant differences were observed for age between the three study groups. Both the overweight/obese groups without diabetes and with Type 2 diabetes had higher BMI than the normal weight group, with no significant differences between overweight/obese participants without diabetes and those with diabetes. Participants with Type 2 diabetes had lower VO(2peak) than overweight/obese participants without diabetes and normal weight individuals (19.6 ± 4.8, 22.6 ± 5.4 and 25.7 ± 5.3 ml kg(-1) min(-1), respectively, P < 0.004 for overall trends). Participants with Type 2 diabetes also had slower recovery in oxygen O(2) kinetics after exercise, compared with both normal weight and overweight/obese individuals without diabetes (56.5 ± 7.7, 49.2 ± 7.2, 47.7 ± 7.4%, P < 0.004 for overall trends). Multiple regression analysis revealed that percentage of oxygen O(2) recovery was a stronger predictor than VO(2peak), BMI or age for fasting glucose and HbA(1c). CONCLUSIONS: Patients with Type 2 diabetes have lower VO(2peak) and prolonged oxygen O(2) recovery from peak exercise. However, only prolonged oxygen O(2) recovery was associated with fasting glucose and HbA(1c).

Inflammation, hepatic enzymes and resistance training in individuals with metabolic risk factors.

AIMS: Increases in inflammatory markers, hepatic enzymes and physical inactivity are associated with the development of the metabolic syndrome (MetS). We examined whether inflammatory markers and hepatic enzymes are correlated with traditional risk factors for MetS and studied the effects of resistance training (RT) on these emerging risk factors in individuals with a high number of metabolic risk factors (HiMF, 2.9 +/- 0.8) and those with a low number of metabolic risk factors (LoMF, 0.5 +/- 0.5). METHODS: Twenty-eight men and 27 women aged 50.8 +/- 6.5 years (mean +/- sd) participated in the study. Participants were randomized to four groups, HiMF training (HiMFT), HiMF control (HiMFC), LoMF training (LoMFT) and LoMF control (LoMFC). Before and after 10 weeks of RT [3 days/week, seven exercises, three sets with intensity gradually increased from 40-50% of one repetition maximum (1RM) to 75-85% of 1RM], blood samples were obtained for the measurement of pro-inflammatory cytokines, C-reactive protein (CRP), gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT). RESULTS: At baseline, HiMF had higher interleukin-6 (33.9%), CRP (57.1%), GGT (45.2%) and ALT (40.6%) levels, compared with LoMF (all P < 0.05). CRP, GGT and ALT correlated with the number of risk factors (r = 0.48, 0.51 and 0.57, respectively, all P < 0.01) and with other anthropometric and clinical measures (r range from 0.26 to 0.60, P < 0.05). RT did not significantly alter inflammatory markers or hepatic enzymes (all P > 0.05). CONCLUSIONS: HiMF was associated with increased inflammatory markers and hepatic enzyme concentrations. RT did not reduce inflammatory markers and hepatic enzymes in individuals with HiMF.

Chromosome structure and eukaryotic gene organization.

The DNA in the eukaryotic nucleus is highly compacted but well organized into distinct regional units. Chromosomal bands are characterized by their structure and distinctive replication time. They are subdivided into chromatin loops which serve as functional domains that have discrete boundary elements and can be regulated during development.

Ammonia, cyclohexane, nitrogen and water adsorption capacities of an activated carbon impregnated with increasing amounts of ZnCl(2), and designed to chemisorb gaseous NH(3) from an air stream.

The adsorption capacity of ZnCl(2)-impregnated activated carbon (AC) for NH(3) is reported in terms of stoichiometric ratio of reaction (NH(3) per ZnCl(2)). This ratio depends on the testing conditions used. Compared to the ratio obtained under dry conditions, the ratio is higher under humid conditions or increased NH(3) concentrations. The linear increase of the NH(3) capacity with increasing loading of ZnCl(2) breaks down at about 3.5 mmol ZnCl(2)/g AC. This behavior is explained in terms of preferential adsorption of a monolayer of salt followed by aggregation of the impregnant once a monolayer is completed. The effect of increasing the loading of ZnCl(2) on the capacity for gases for which the impregnants are not intended, namely cyclohexane, nitrogen, and water vapor, is also discussed. A break in the linear relationship between water capacity and impregnant loading at about 3.5 mmol ZnCl(2) seems to correspond to a full monolayer coverage of ZnCl(2) on AC. The monolayer of ZnCl(2) is shown to reduce the uptake of water into AC, while the ZnCl(2) aggregates are shown to be hydrophilic.

The role of angiotensin II in the development of hypertension and in the maintenance of glomerular filtration rate during 48 hours of renal artery stenosis in conscious dogs.

The responses to 48 h of renal artery stenosis were compared in uninephrectomized, chronically-instrumented dogs with or without inhibition of angiotensin II (AII) formation by enalapril. Mean arterial pressure rose by an average of 29.9 mmHg (s.e.m. 3.5) in untreated dogs and by 14.5 mmHg (s.e.m. 2.8) in enalapril-treated dogs over the two days of stenosis. Renal artery stenosis reduced glomerular filtration rate (GFR) by 49% (s.e.m. 9) in untreated dogs and by 86% (s.e.m. 8) in enalapril-treated dogs. Compared to untreated dogs, enalapril-treated dogs also had lower renal artery pressure distal to the stenosis, drank less water and had larger rises in plasma K+ following renal artery stenosis. There were no differences in renal blood flow or urinary Na+ excretion in the two groups of dogs. Thus blockade of AII production did not prevent hypertension occurring in response to renal artery stenosis, but the rise in blood pressure was only about half that which occurred in normal dogs and GFR was much more severely reduced.

Resistance exercise training increases muscle strength, endurance, and blood flow in patients with chronic heart failure.

Resistance exercise training was well tolerated in patients with stable, chronic heart failure, resulting in increased strength and endurance, and lower oxygen consumption at submaximum workloads but no improvement in VO2peak. There was also a significant increase in basal forearm blood flow following this form of exercise training.

Creatine supplementation increases muscle total creatine but not maximal intermittent exercise performance.

This study investigated creatine supplementation (CrS) effects on muscle total creatine (TCr), creatine phosphate (CrP), and intermittent sprinting performance by using a design incorporating the time course of the initial increase and subsequent washout period of muscle TCr. Two groups of seven volunteers ingested either creatine [Cr; 6 x (5 g Cr-H(2)O + 5 g dextrose)/day)] or a placebo (6 x 5 g dextrose/day) over 5 days. Five 10-s maximal cycle ergometer sprints with rest intervals of 180, 50, 20, and 20 s and a resting vastus lateralis biopsy were conducted before and 0, 2, and 4 wk after placebo or CrS. Resting muscle TCr, CrP, and Cr were unchanged after the placebo but were increased (P < 0.05) at 0 [by 22.9 +/- 4.2, 8.9 +/- 1.9, and 14.0 +/- 3.3 (SE) mmol/kg dry mass, respectively] and 2 but not 4 wk after CrS. An apparent placebo main effect of increased peak power and cumulative work was found after placebo and CrS, but no treatment (CrS) main effect was found on either variable. Thus, despite the rise and washout of muscle TCr and CrP, maximal intermittent sprinting performance was unchanged by CrS.

Effect of creatine supplementation on sprint exercise performance and muscle metabolism.

The aim of the present study was to examine the effect of creatine supplementation (CrS) on sprint exercise performance and skeletal muscle anaerobic metabolism during and after sprint exercise. Eight active, untrained men performed a 20-s maximal sprint on an air-braked cycle ergometer after 5 days of CrS [30 g creatine (Cr) + 30 g dextrose per day] or placebo (30 g dextrose per day). The trials were separated by 4 wk, and a double-blind crossover design was used. Muscle and blood samples were obtained at rest, immediately after exercise, and after 2 min of passive recovery. CrS increased the muscle total Cr content (9.5 +/- 2.0%, P < 0.05, mean +/- SE); however, 20-s sprint performance was not improved by CrS. Similarly, the magnitude of the degradation or accumulation of muscle (e.g., adenine nucleotides, phosphocreatine, inosine 5'-monophosphate, lactate, and glycogen) and plasma metabolites (e.g. , lactate, hypoxanthine, and ammonia/ammonium) were also unaffected by CrS during exercise or recovery. These data demonstrated that CrS increased muscle total Cr content, but the increase did not induce an improved sprint exercise performance or alterations in anaerobic muscle metabolism.

Pre-exercise carbohydrate ingestion: effect of the glycemic index on endurance exercise performance.

PURPOSE: This study aimed to examine the effect of glycemic index of pre-exercise carbohydrate (CHO) ingestion on exercise metabolism and performance. METHODS: Eight endurance trained men ingested a high glycemic index (HGI), low glycemic index (LGI), or a placebo (CON) meal 45 min before exercise and then cycled for 50 min at 67% VO2max. Subjects subsequently performed a 15-min self-paced performance ride in which total work (kJ) was recorded. RESULTS: Plasma glucose concentrations were higher (P < 0.01) after ingestion in HGI compared with LGI and CON (7.53 +/- 0.64 vs 5.55 +/- 0.21 and 4.65 +/- 0.14 mmol.L-1 for HGI, LGI, and CON, respectively, 30 min postprandial; mean +/- SE) but declined at the onset of exercise and were lower (P < 0.01) compared with LGI and CON (4.03 +/- 0.31 vs 4.64 +/- 0.24 and 5.09 +/- 0.16 mmol.L-1 for HGI, LGI, and CON respectively; mean +/- SE) at 10 min of exercise. Plasma glucose remained depressed (P < 0.01) until 30 min into exercise in HGI compared with other trials. Plasma insulin concentrations were higher (P < 0.01) following ingestion during rest and exercise in HGI compared with LGI and CON. Plasma FFA concentrations were lower (P < 0.05) following ingestion in HGI and LGI compared with CON and higher (P < 0.05) in LGI compared with HGI at the start and end of exercise. RER and CHO oxidation was higher (P < 0.01) in HGI compared with LGI and CON during submaximal exercise. There were no differences in work output during the performance cycle. CONCLUSIONS: These data indicate that pre-exercise CHO feedings with varying glycemic indexes do not affect exercise performance following short term submaximal exercise despite alterations in metabolism.

Effect of CHO ingestion on exercise metabolism and performance in different ambient temperatures.

Two series of experiments were conducted to examine the effect of ingesting beverages with differing carbohydrate (CHO) concentrations and osmolalities on metabolism and performance during prolonged exercise in different environmental conditions. In series 1, 12 subjects performed three cycling exercise trials to fatigue at 70% VO2peak in either 33 degrees C (N = 6) (HT1) or 5 degrees C (N = 6) (CT). Subjects ingested either a 14% CHO solution (osmolality = 390 mosmol.1(-1) (HCHO); a 7% CHO solution (330 mosmol.1(-1) (NCHO) or a placebo (90 mosmol.1(-1) (CON1). In series 2, six subjects performed the same three trials at 33 degrees C (HT2), while ingesting either NCHO, a 4.2% CHO solution (240 mosmol.1(-1) (LCHO) or a placebo) (240 mosmol.1(-1) (CON2). Plasma glucose was higher (P < 0.05) in HCHO than NCHO, which in turn was higher (P < 0.05) than CON1 in both CT and HT1. Plasma glucose was lower (P < 0.05) in CON2 compared with NCHO and LCHO in HT2. The fall in plasma volume was greater (P < 0.05) in HCHO than other trials in both CT and HT1 but was not different when comparing the three trials in HT2. Exercise time was not different when comparing the trials in either HT1 or HT2 but was longer (P < 0.05) in NCHO compared with HCHO, which, in turn, was longer (P < 0.05) than CON1 in CT. These data demonstrate that, during prolonged exercise in the heat, fatigue is related to factors other than CHO availability. In addition, during exercise in 5 degrees C a 7% CHO solution is more beneficial for exercise performance than a 14% CHO solution.

Ethical dimensions of intergenerational reciprocity: implications for practice.

This paper reviews the moral and ethical context of family relationships and caregiver stress, with an emphasis on the implications for professional interventions. Three views of filial responsibility are presented: parental reverence, a debt of gratitude, and caregiving as an expression of friendship and love. Case studies are presented to illustrate how an exploration of ethically defensible limits to caregiving might proceed.

Integrating health and mental health: opportunities in undergraduate health programs.

A common goal of mental health professionals is to increase the degree of integration of mental health within the primary health care system. Achieving interpretation of mental health within the larger health care system requires teaching diagnostic and treatment skills, as well as a value orientation which ascribes greater importance to mental health and mental health problems. Teaching a new value orientation is best introduced early in one's educational career rather than postponing such intervention until post-graduate medical residency programs. Results of a survey are presented which indicate the variable mental health content included in undergraduate health related programs. The goal of greater integration between mental health and health can clearly be furthered by beginning to teach this critical value orientation in undergraduate health programs.

Keeping volunteers in EMS* (*emergency medical services).

The EMS system is widely dependent on the use of volunteers. This report of a study of EMS in Genesee County, Michigan, covers the volunteers' point of view on their attraction to the field and job satisfaction as well as the agency's response to recruitment and retention issues.

Library instruction for medical students.

The library instruction program for medical students at the University of Tennessee Center for the Health Sciences is described. This instruction program, which was developed in cooperation with the medical faculty, is included in the College of Medicine curriculum. Library instruction is presented sequentially at scheduled times during the four-year curriculum when students need specific information. The development, implementation, and evaluation of the program are discussed.

Application of a general database manager in a clinical medical librarian program.

The morning report reference file was automated at the Stollerman Library because the manual system was time-intensive to maintain and cumbersome to search. A general database management system (DBMS) was chosen so that it could be used in the future for other data management functions in the library. DBMS features that should be examined before use with a bibliographic application include size limitations, data entry forms, data types, search options, index files, sort options, report generation, query and programming languages, command and/or menu files, file interaction, interface with other software, and documentation. Desired requirements for this application are discussed. It is noted that a general database manager probably will not meet all of the desired requirements. For some bibliographic applications, software specifically designed for bibliographic information management and retrieval should be used. A database for the purposes of searching the morning report reference file and producing a weekly reference list and a yearly index was developed using CONDOR 3. The structure of the database is described, and examples of the reports are given. The system has been in operation since December 1984 and has been well-received by staff and patrons.