Sleep deprivation, energy expenditure and cardiorespiratory function.

Participants in the sport of adventure racing often choose to go without sleep for a period of greater than 24 h while partaking in prolonged submaximal exercise. This study examined the effect of 30 h of sleep deprivation and intermittent physical exercise, on the cardiorespiratory markers of submaximal exercise in six subjects. Six subjects with the following physical characteristics participated in the study (mean +/- SD): age 22 +/- 0.3 years, height 180 +/- 5 cm, body mass: 77 +/- 5 kg, VO2peak 44 +/- 5 ml. kg (-1). min (-1). Three subjects engaged in normal sedentary activities while three others cycled on a cycle ergometer at 50 % VO2peak for 20 min out of every two hours during thirty hours of sleep deprivation. One week later sleep deprivation was repeated with a cross over of subjects. Every four hours, subjects completed assessments of cardiorespiratory function during 50 % VO2peak cycling. A 3 x 8 repeated measures ANOVA revealed a significantly lower heart rate with sleep deprivation (p < 0.05), but no other significant effects (p > 0.05) on respiratory gas exchange variables. Neither sleep deprivation, nor a combination of sleep deprivation and five hours of moderate intensity cycling, appear to be limiting factors to the physiological capacity to perform submaximal exercise.

Needs and program strengths: perceptions of hospice volunteers.

A state-wide survey was conducted of highly effective hospice volunteers who were questioned about their motivations for becoming a volunteer, training experience and needs, and reasons for continuing in the volunteer role. Needs identified included having a volunteer support group, on-going training opportunities, and opportunities for getting to know other volunteers better. Excellent training, belief in the hospice mission, the relationship with staff, feeling valued, and personal fulfillment were strengths and motivations to continue as a hospice volunteer. Findings from the study will be helpful to hospice staff who recruit, train, and support volunteers.

Heart-lung transplantation for cystic fibrosis. 1: Assessment.

Forty five patients with cystic fibrosis (age 5-15 years) were assessed for heart-lung transplantation between September 1987 and March 1990. The two main conditions for acceptance were (i) life expectancy less than 2 years and (ii) a severely impaired quality of life. Patients were accepted onto an active waiting list (n = 26), a provisional waiting list (n = 15), or not accepted (n = 4). Selection was made on clinical grounds with objective measurements used as an aid in assessment. As expected, the mean values for objective measures were significantly different between patients on the active waiting list compared with the provisional waiting list/not accepted group for resting heart rate (118/minute v 101/minute), percentage of ideal weight (83.2% v 93.1%), forced expiratory volume at one second as percent of predicted normal (27.3% v 47.6%), Shwachman-Kulczycki score (33.6 v 52.5), Chrispin-Norman x ray score (25.8 v 22.1), 12 minute walk (540 m v 854 m), and minimal oxygen saturation (81.5% v 92%). Psychological evaluation demonstrated a 55% incidence of individual and a 50% incidence of family morbidity. Of the 26 patients accepted onto the active waiting list, 11 have been transplanted (mean waiting time 3.3 months), 10 have died within a mean of 3.7 months of acceptance, and five remain on the active list (mean 5.6 months).

Simultaneous collection of platelets and cryoprecipitate by plasma-exchange donation.

To increase cost efficiency, the simultaneous collection of platelets during plasma-exchange donation of cryoprecipitate was investigated. Sixteen desmopressin (DDAVP)-stimulated donors underwent 90 simultaneous donations. Permanent donor plasma loss for each donation averaged 150 ml in cryoprecipitate and 151 ml in platelet concentrates. Mean factor VIII (FVIII) yield was 4699 +/- 2754 IU per donation. The mean yield in the platelet products was 4.63 X 10(11) platelets; aggregation properties and posttransfusion increments were satisfactory. White cell contamination averaged 4.05 X 10(9) but could be lowered by a secondary centrifugation. The direct cost for a single-donor platelet transfusion produced in this way is estimated at $102.19 and that for FVIII at $0.055 per IU. Simultaneous donation is technically feasible and safe for donors, and it provides functional products that are more cost-effective than apheresis platelets or cryoprecipitate donated separately.

A high-potency, single-donor cryoprecipitate of known factor VIII content dispensed in vials.

Current factor VIII products expose recipients to many donors and hence to a high risk of acquiring blood-borne infections. Plasma-exchange donation of cryoprecipitate can reduce donor exposure by repeatedly obtaining large yields of factor VIII from individual donors. In this study, donor factor VIII levels were stimulated with desmopressin before donation. Mean yield per donation increased from 1399 +/- 425 IU in controls to 3818 +/- 1350 IU in stimulated donations (p less than 0.001), and mean factor VIII concentration in the cryoprecipitate increased from 8.2 +/- 3 IU/mL to 24 +/- 12 IU/mL (p less than 0.001). A new packaging system dispenses assayed aliquots of stimulated cryoprecipitate in plastic vials. The direct cost of production for this material is $.065 per unit. The cryoprecipitate is hemostatically active and convenient to use, and the aggregate yields from sequential donations by stimulated persons are high enough to allow long-term, single-donor support of many adults with hemophilia.

Equity considerations in the friendships of older adults.

This study examined patterns of exchange between 110 older adults and their friends. Using equity theory as the conceptual base, the amount and type of distress reported in the overall friend relationship, the helping aspect of the friendship, and the affective component of the relationship by those individuals in equitable versus inequitable friendships were examined. The results support the postulate of equity theory that individuals who perceived their relationship to be equitable express less distress with all aspects of their friendships than those who perceived their friendships as inequitable. The type of distress reported by respondents in the inequitable group, however, was contrary to the propositions of equity theory.