Acute Responses to Cycling Exercise With Blood Flow Restriction During Various Intensities.

ABSTRACT: Lauver, JD, Moran, A, Guilkey, JP, Johnson, KE, Zanchi, NE, and Rotarius, TR. Acute responses to cycling exercise with blood flow restriction during various intensities. J Strength Cond Res 36(12): 3366-3373, 2022-The purpose of this study was to investigate the acute physiological responses during cycling at various intensities with blood flow restriction (BFR). Subjects ( N = 9; V̇ o2 peak = 36.09 ± 5.80 ml·kg -1 ·min -1 ) performed 5 protocols: high-intensity (HIGH), control (CON-90), 90% of ventilatory threshold (VT) work rate with BFR (90-BFR), 70% of VT with BFR (70-BFR), and 30% V̇ o2 peak with BFR (30-BFR). Protocols consisted of five 2-minute work intervals interspersed with 1-minute recovery intervals. Blood flow restriction pressure was 80% of limb occlusion pressure. V̇ o2 , muscle excitation, tissue oxygen saturation (StO 2 ), discomfort, and level of perceived exertion (RPE) were assessed. Muscle excitation was higher during HIGH (302.9 ± 159.9 %BSL [baseline]) compared with 70-BFR (99.7 ± 76.4 %BSL) and 30-BFR (98.2 ± 70.5 %BSL). StO 2 was greater during 90-BFR (40.7 ± 12.5 ∆BSL), 70-BFR (34.4 ± 15.2 ∆BSL), and 30-BFR (31.9 ± 18.7 ∆BSL) compared with CON-90 (4.4 ± 11.5 ∆BSL). 90-BFR (39.6 ± 12.0 ∆BSL) resulted in a greater StO 2 -Avg compared with HIGH (20.5 ± 13.8 ∆BSL). Also, HIGH (23.68 ± 5.31 ml·kg -1 ·min -1 ) resulted in a greater V̇ o2 compared with 30-BFR (15.43 ± 3.19 ml·kg -1 ·min -1 ), 70-BFR (16.65 ± 3.26 ml·kg -1 ·min -1 ), and 90-BFR (18.28 ± 3.89 ml·kg -1 ·min -1 ); 90-BFR (intervals: 4 = 15.9 ± 2.3; intervals: 5 = 16.4 ± 2.5) resulted in a greater RPE compared with 30-BFR (intervals: 4 = 13.3 ± 1.4; intervals: 5 = 13.7 ± 1.7) during intervals 4 and 5. These results suggest that when adding BFR to various intensities of aerobic exercise, consideration should be given to peak work and VT to provide a balance between high local physiological stress and perceptual responses.

Acute Neuromuscular and Microvascular Responses to Concentric and Eccentric Exercises With Blood Flow Restriction.

Lauver, JD, Cayot, TE, Rotarius, TR, and Scheuermann, BW. Acute neuromuscular and microvascular responses to concentric and eccentric exercises with blood flow restriction. J Strength Cond Res 34(10): 2725-2733, 2020-The purpose of this study was to investigate the effects of the addition of blood flow restriction (BFR) during concentric and eccentric exercises on muscle excitation and microvascular oxygenation status. Subjects (N = 17) were randomly assigned to either a concentric (CON, CON + BFR) or eccentric (ECC, ECC + BFR) group, with one leg assigned to BFR and the other to non-BFR. Surface electromyography and near-infrared spectroscopy were used to measure muscle excitation and microvascular deoxygenation (deoxy-[Hb + Mb]) and [total hemoglobin concentration] during each condition, respectively. On separate days, subjects completed 4 sets (30, 15, 15, 15) of knee extension exercise at 30% maximal torque, and 1 minute of rest was provided between the sets. Greater excitation of the vastus medialis was observed during CON + BFR (54.4 ± 13.3% maximal voluntary isometric contraction [MVIC]) and ECC + BFR (53.0 ± 18.0% MVIC) compared with CON (42.0 ± 10.8% MVIC) and ECC (46.8 ± 9.6% MVIC). Change in deoxy-[Hb + Mb] was greater during CON + BFR (10.0 ± 10.4 µM) than during CON (4.1 ± 4.0 µM; p < 0.001). ECC + BFR (7.8 ± 6.7 µM) was significantly greater than ECC (3.5 ± 4.7 µM; p = 0.001). Total hemoglobin concentration was greater for ECC + BFR (7.9 ± 4.4 µM) compared with ECC (5.5 ± 3.5 µM). The addition of BFR to eccentric and concentric exercises resulted in a significant increase in metabolic stress and muscle excitation compared with non-BFR exercise. These findings suggest that although BFR may increase the hypertrophic stimulus during both modes of contraction, BFR during concentric contractions may result in a greater stimulus.

Population Health Initiatives Among Hospitals: Associated Hospital Characteristics.

EXECUTIVE SUMMARY: This study explored how hospitals define population health and the factors associated with hospitals' population health initiatives. Data came from the 2015 American Hospital Association (AHA) Population Health Survey, the 2015 AHA Annual Survey, and the 2015 AHA Health Information Technology Supplement. Descriptive statistics described the sample of 1,386 nonfederal acute care hospitals and variables of interest. Multivariate logistic regression explored associations between population health commitment among hospitals and hospital characteristics. While hospitals defined population health in several ways, most (83%) responded that they were committed to population health activities. Multivariate regression results indicated that hospitals with lower levels of health information technology sophistication were less likely to commit to population health activities. For-profit hospitals were also less likely to commit to population health, compared to not-for-profit hospitals. System members were more likely to commit to population health initiatives, compared to independent hospitals. The variation in the definition of population health has implications for developing strategies to improve outcomes. These results present preliminary evidence on the relationship between hospital characteristics and hospital commitment to population health efforts.

Health Care Leadership: Managing Knowledge Bases as Stakeholders.

Communities are composed of many organizations. These organizations naturally form clusters based on common patterns of knowledge, skills, and abilities of the individual organizations. Each of these spontaneous clusters represents a distinct knowledge base. The health care knowledge base is shown to be the natural leader of any community. Using the Central Florida region's 5 knowledge bases as an example, each knowledge base is categorized as a distinct type of stakeholder, and then a specific stakeholder management strategy is discussed to facilitate managing both the cooperative potential and the threatening potential of each "knowledge base" stakeholder.

Using Technology to Improve Access to Mental Health Services.

Mental ill-health is a public health threat that is prevalent throughout the United States. Tens of millions of Americans have been diagnosed along the continuum of mental ill-health, and many more millions of family members and friends are indirectly affected by the pervasiveness of mental ill-health. Issues such as access and the societal stigma related to mental health issues serve as deterrents to patients receiving their necessary care. However, technological advances have shown the potential to increase access to mental health services for many patients.

The effect of eccentric exercise with blood flow restriction on neuromuscular activation, microvascular oxygenation, and the repeated bout effect.

PURPOSE: To examine the effect of low-intensity eccentric contractions with and without blood flow restriction (BFR) on microvascular oxygenation, neuromuscular activation, and the repeated bout effect (RBE). METHODS: Participants were randomly assigned to either low-intensity (LI), low-intensity with BFR (LI-BFR), or a control (CON) group. Participants in LI and LI-BFR performed a preconditioning bout of low-intensity eccentric exercise prior to about of maximal eccentric exercise. Participants reported 24, 48, 72, and 96 h later to assess muscle damage and function. Surface electromyography (sEMG) and near-infrared spectroscopy (NIRS) were used to measure neuromuscular activation and microvascular deoxygenation (deoxy-[Hb + Mb]) and [total hemoglobin] ([THC]) during the preconditioning bout, respectively. RESULTS: During set-2, LI-BFR resulted in greater activation of the VM-RMS (47.7 ± 11.5% MVIC) compared to LI (67.0 ± 20.0% MVIC), as well as during set-3 (p < 0.05). LI-BFR resulted in a greater change in deoxy-[Hb + Mb] compared to LI during set-2 (LI-BFR 13.1 ± 5.2 µM, LI 6.7 ± 7.9 µM), set-3 (LI-BFR 14.6 ± 6 µM, LI 6.9 ± 7.4 µM), and set-4 (p < 0.05). [THC] was higher during LI-BFR compared to LI (p < 0.05). All groups showed a decrease in MVIC torque immediately after maximal exercise (LI 74.2 ± 14.1%, LI-BFR 75 ± 5.1%, CON 53 ± 18.6%). At 24, 48, 72, and 96 h post maximal eccentric exercise, LI and LI-BFR force deficit was not different from baseline. CONCLUSION: This study suggests that the neuromuscular and deoxygenation (i.e., metabolic stress) responses were considerably different between LI and LI-BFR groups; however, these differences did not lead to improvements in the RBE inferred by performing LI and LI-BFR.

Comparing the Financial Impact of Several Hospitals on Their Local Markets.

Several studies that measured the financial impact of hospitals on their local markets are examined. Descriptive analyses were performed to ascertain if there are any identifying characteristics and emerging patterns in the data. After hospitals were categorized into small, medium, and large classifications based on the number of employees, various predictive insights were discovered. Smaller hospitals could be expected to contribute approximately 7.3% to the local economy, whereas medium-sized hospitals would likely contribute approximately 11.4% to the financial value of the local market. Finally, larger hospitals may contribute approximately 16% to their local economies.

Information Delivery in Health Care: Preparing a Professional Presentation to Key Stakeholders.

Today's professional health care managers are routinely asked to share information with important stakeholders. For example, the manager of a clinical practice may be asked to present to physician owners the financial effects to be expected from a new managed care contract that will likely include lower reimbursements. When faced with these types of information requests, health care managers must find the best method of delivering information to their key stakeholders. This article presents a structured approach that health care management can use to prepare presentations to key stakeholders about different types of situations that are likely be encountered during a professional career.

Preparing a Health Care White Paper: Providing Structure to the Writing Process.

Health care leaders operate in a very complex and turbulent business environment. Both government regulations and market forces are very active in the industry. Thus, health care managers have many multifaceted and, sometimes, contradictory expectations placed upon them and their organizations. To ensure professional accountability, health care executives often join professional associations and strive for licenses and certifications that are intended to place the professional above the rest. One important avenue to achieve various licensing and certification accomplishments involves writing a white paper about a specific topic of interest to the industry and organization. Presented herein are structural processes that facilitate the creation and preparation of a health care white paper. Both conceptual and empirical structures of white papers are presented, with the similarities and the differences between conceptual and empirical papers highlighted.

Regional Interrelationships: A Leadership Opportunity for Health Care.

Given the impact that the health care industry has on the national economy, health care executives need to move beyond simply providing health care treatments and instead focus on strategically leading their regions, including the other key industry contributors in their specific regions. Geographic and economic regions can be viewed as concentric circles of influence, with each circle recognizing the resources and contributions that are specific to a region. An acknowledgement by health care executives of the regional interrelationships that exist in a specific region is necessary for health care managers to strategically lead regional interrelationships. A template for implementation of this process is included. To understand the various factors that exist within circles of influence, several distinct yet interrelated vertical bases of knowledge will be discussed. The 5 bases of knowledge examined here include the following: Health Care, Tourism, Defense and Technology, Education, and Retail. It is important to note that the resources identified in the Tourism, Defense and Technology, Education, and Retail knowledge bases all have a direct influential relationship upon the health care resources of the region. For description purposes, the Central Florida geographic and economic region will be examined for interrelationships between the 5 knowledge bases.

Health Care Affordability: How to Make It a Reality.

Health care is a big business. US health care expenditures reached $2.9 trillion in 2013. Patient spending accounted for 28% of the total, which means patients spent approximately $810 billion in 2013 for insurance premiums, deductibles, copays, coinsurance, and noncovered health care services. How are patients expected to pay almost a trillion dollars in health care expenses? There is a need to find a health care financing methodology that will make health care affordable for all patients and families. An alternative method for funding health care is discussed that includes creating a government-funded annuity during the first decade of one's life. When this annuity matures later in life, many individuals will have amassed a large pot of money with which to pay for their (and their family's) health care treatment and products.

The financial impact of hospitals on the local economy--2 new factors.

This research effort presents a descriptive analysis of the financial impact that several hospitals have on their local economy. An earlier study published by the authors included 3 distinct, yet overlapping components of financial impact: (1) the hospital system as a major health care provider, (2) the hospital system as a large employer, and (3) the hospital system as an entity whose employees contribute greatly to their local community. This new study added additional financial impact factors: (4) the hospital system as an organization committed to major construction projects in pursuit of its health services mission, and (5) the hospital system as an entity that pays taxes to government agencies. The inextricable relationship of these 5 categories both increases and enhances the impact of the hospital system on the local region. The results of this updated and expanded analysis suggest strongly that the hospital system represents 1 of the primary contributors to the economy of the region. The hospital system adds $3 billion to the $28 billion local economy, which means that the hospital system and its employees are responsible for 10.7% of the total economic prowess of the region.

Emergency department utilization at a large regional hospital: a strategy for survivability.

This research effort provides a brief picture of the operational, patient, and financial patterns of the multiple emergency departments of a large hospital system located in the southeastern United States. The results are presented anonymously as a descriptive case study. A multifaceted strategy is presented to assist hospital leaders as they strive to ensure the survivability of their emergency departments in this era of high uncompensated care.

The effects of national health care reform on local businesses--part 1. The law and its applicability.

This is part 1 of a 3-part series that presents a comprehensive examination of the results that can be expected from the 2010 national Health Care Reform legislation. Political pundits have speculated endlessly on the many changes mandated by the legislation, titled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that members of the business community and their employees will benefit from the legislation early on (years 1-3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (year 4 onward). Businesses will likely be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be newly-insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

The effects of national health care reform on local businesses--part II: study methodology and primary research questions.

This is the second part of a 3-part examination of what may be potentially expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that, nationally, members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (year 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be-newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

The effects of national health care reform on local businesses--Part III: secondary research questions--discoveries and implications.

This is the third part of a 3-part examination of what may potentially be expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that nationally members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (years 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

Internal marketing: creating quality employee experiences in health care organizations.

To cope with the recent challenges within the health care industry, health care managers need to engage in the internal marketing of their various services. Internal marketing has been used as an effective management tool to increase employees' motivation, satisfaction, and productivity (J Mark Commun. 2010;16(5):325-344). Health care managers should understand that an intense focus on internal marketing factors will lead to a quality experience for employees that will ultimately have a positive effect on the patient experiences.

The laboratory workforce shortage: a managerial perspective.

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

Health care transitions and the aging population: a framework for measuring the value of rapid rehabilitation.

A study was undertaken to establish a framework to measure the value of rapid rehabilitation and identify indicators to quantify effective outcomes and efficient processes as health care services are delivered to the aging population across providers, services, and settings. The rapid rehabilitation protocol serving as intervention in this research provides patients (≥65 years old) the option to transition from the acute-care hospital, early in the continuum of care, to an outpatient, skilled nursing facility operated by a division of the hospital organization. A quasi-experimental, cross-sectional, retrospective study is designed to identify and quantify the relationships present in processes and outcomes inherent in health care transitions. Statistical analysis yields unexpected relationships with limited explanatory power for the selected indicators: length of stay, cost of care, discharge delays, 30-day readmissions, falls, and patient satisfaction. However, this research finds 4 imperatives for hospital and clinical leadership: (1) increase collaboration across providers, settings, and stakeholders; (2) educate workforce to optimize risk assessment of aging population; (3) standardize critical to quality measures as scientific foundation for management of services; (4) invest in technologies to ensure the integrity, validity, and reliability of information used to draw inferences about services, risk, and performance.

Muscle blood flow is independent of conduit artery diameter following prior vasodilation in males.

At the onset of exercise in humans, muscle blood flow (MBF) increases to a new steady-state that closely matches the metabolic demand of exercise. This increase has been attributed to "contraction-induced vasodilation," comprised of the skeletal muscle pump and rapid vasodilatory mechanisms. While most research in this area has focused on forearm blood flow (FBF) and vascular conductance, it is possible that separating FBF into diameter and blood velocity can provide more useful information on MBF regulation downstream of the conduit artery. Therefore, we attempted to dissociate the matching of oxygen delivery and oxygen demand by administering glyceryl tri-nitrate (GTN) prior to handgrip exercise. Eight healthy males (29 ± 9 years) performed two trials consisting of two bouts of rhythmic handgrip exercise (30 contractions·min-1 at 5% of maximum) for 6 min, one for each control and GTN (0.4 mg sublingual) condition. Administration of GTN resulted in a 12% increase in resting brachial artery diameter that persisted throughout the duration of exercise (CON: 0.50 ± 0.01 cm; GTN: 0.56 ± 0.01 cm, p < 0.05). Resting FBF was greater following GTN administration compared to control (p < 0.05); however, differences in FBF disappeared following the onset of muscle contractions. Our results indicate that the matching of FBF to oxygen demand during exercise is not affected by prior vasodilation, so that any over-perfusion is corrected at the onset of exercise. Additionally, our findings provide further evidence that the regulation of vascular tone within the microvasculature is independent of the conduit artery diameter.