Differences in history-taking skills between male and female chiropractic student interns.

OBJECTIVE: The purpose of this study was to determine if there was a difference in history-taking skills between male and female chiropractic student interns. METHODS: This study included 2040 patient histories collected by student interns over a 3-year period. Students were assessed by chiropractic college clinicians on reasoning (ability to derive clinically relevant information using a mnemonic for taking a history), communication, and professionalism using a modified Dreyfus model scoring system on a 1-4 scale (1 = novice, 4 = proficient). Ordinal dependent variables were scores for reasoning, communication, and professionalism. The categorical independent variable was sex of the student intern (male or female). A Mann-Whitney U test was used to compare for differences in nonparametric dependent variables by the sex of the students. RESULTS: The Mann-Whitney U test revealed that communication scores were greater for female chiropractic interns compared with male chiropractic interns (p < .001, with a small effect size (r = -.08). There was no statistically significant effect for sex on reasoning (p = .263) or professionalism (p = .098). CONCLUSION: Female chiropractic student interns scored higher than male interns on communication skills during a history-taking patient encounter. This supports the trend seen among female medical school students and physicians that women score higher than men on communication-related assessments.

Interactions between the sex of the clinician grader and the sex of the chiropractic student intern on spinal manipulation assessment grade.

OBJECTIVE: The purpose of this project was to determine if there was any relationship between the sex of the clinician grader and the sex of the chiropractic student intern on student spinal manipulation assessment grades. METHODS: Twelve thousand six hundred and thirty-one supervised patient adjustments by student interns were analyzed over a 3-year data collection window. Student interns were assessed by multiple male and female clinicians in a teaching clinic using a modified Dreyfus model scoring system on a 1-4 scale (1 = novice, 4 = proficient). A Mann-Whitney U test was used to compare the relationship between grader sex and student grade as well as student sex and student grade. RESULTS: Sex of the grader had a statistically significant effect on spinal manipulation assessment grade, p < .001, with male clinician graders assigning average scores of 2.81 ± 0.39 (mean ± SD) and female clinician graders scores of 3.01 ± 0.52, r = .18. Sex of the student had a statistically significant but negligible (r = .08) effect on spinal manipulation assessment grade, p < .001, with male students averaging slightly higher scores (2.93 ± 0.47) than females (2.86 ± 0.44) on the modified Dreyfus scale. CONCLUSION: Male clinicians tended to assign lower grades on spinal manipulation assessments than female clinicians. Male students on average received slightly higher scores than female students on spinal manipulation assessments.

Synergistic action of thermophilic pectinases for pectin bioconversion into D-galacturonic acid.

Large amounts of pectin-rich biomass are generated worldwide yearly, which can be hydrolysed by pectinases to obtain bio-based chemical building blocks such as D-galacturonic acid (GalA). The aim of this work was to investigate thermophilic pectinases and explore their synergistic application in the bioconversion of pectic substrates into GalA. Two exo-polygalacturonases (exo-PGs) from Thermotoga maritima (TMA01) and Bacillus licheniformis (BLI04) and two pectin methylesterases (PMEs) from Bacillus licheniformis (BLI09) and Streptomyces ambofaciens (SAM10) were cloned and expressed in Escherichia coli BL21 (DE3), purified and fully characterised. These pectinases exhibited optimum activity at temperatures above 50 °C and good stability at high temperature (40-90 °C) for up to 24 h. Exo-PGs preferred non-methylated substrates, suggesting that previous pectin demethylation by PMEs was necessary to achieve an efficient pectin monomerisation into GalA. Synergistic activity between PMEs and exo-PGs was tested using pectin from apple, citrus and sugar beet. GalA was obtained from apple and citrus pectin in a concentration of up to 2.5 mM after 4 h reaction at 50 °C, through the combined action of BLI09 PME with either TMA01 or BLI04 exo-PGs. Overall, this work contributes to expand the knowledge of pectinases from thermophiles and provides further insights into their application in the initial valorisation of sustainable pectin-rich biomass feedstocks.

Mathematical modelling of a liver hollow fibre bioreactor.

A mathematical model has been developed to assist with the development of a hollow fibre bioreactor (HFB) for hepatotoxicity testing of xenobiotics; specifically, to inform the HFB operating set-up, interpret data from HFB outputs and aid in optimizing HFB design to mimic certain hepatic physiological conditions. Additionally, the mathematical model has been used to identify the key HFB and compound parameters that will affect xenobiotic clearance. The analysis of this model has produced novel results that allow the operating set-up to be calculated, and predictions of compound clearance to be generated. The mathematical model predicts the inlet oxygen concentration and volumetric flow rate that gives a physiological oxygen gradient in the HFB to mimic a liver sinusoid. It has also been used to predict the concentration gradients and clearance of a test drug and paradigm hepatotoxin, paracetamol (APAP). The effect of altering the HFB dimensions and fibre properties on APAP clearance under the condition of a physiological oxygen gradient is analysed. These theoretical predictions can be used to design the most appropriate experimental set up and data analysis to quantitatively compare the functionality of cell types that are cultured within the HFB to those in other systems.

Protein CoAlation and antioxidant function of coenzyme A in prokaryotic cells.

In all living organisms, coenzyme A (CoA) is an essential cofactor with a unique design allowing it to function as an acyl group carrier and a carbonyl-activating group in diverse biochemical reactions. It is synthesized in a highly conserved process in prokaryotes and eukaryotes that requires pantothenic acid (vitamin B5), cysteine and ATP. CoA and its thioester derivatives are involved in major metabolic pathways, allosteric interactions and the regulation of gene expression. A novel unconventional function of CoA in redox regulation has been recently discovered in mammalian cells and termed protein CoAlation. Here, we report for the first time that protein CoAlation occurs at a background level in exponentially growing bacteria and is strongly induced in response to oxidizing agents and metabolic stress. Over 12% of Staphylococcus aureus gene products were shown to be CoAlated in response to diamide-induced stress. In vitro CoAlation of S. aureus glyceraldehyde-3-phosphate dehydrogenase was found to inhibit its enzymatic activity and to protect the catalytic cysteine 151 from overoxidation by hydrogen peroxide. These findings suggest that in exponentially growing bacteria, CoA functions to generate metabolically active thioesters, while it also has the potential to act as a low-molecular-weight antioxidant in response to oxidative and metabolic stress.

Probing binding specificity of the sucrose transporter AtSUC2 with fluorescent coumarin glucosides.

The phloem sucrose transporter, AtSUC2, is promiscuous with respect to substrate recognition, transporting a range of glucosides in addition to sucrose, including naturally occurring coumarin glucosides. We used the inherent fluorescence of coumarin glucosides to probe the specificity of AtSUC2 for its substrates, and determined the structure-activity relationships that confer phloem transport in vivo using Arabidopsis seedlings. In addition to natural coumarin glucosides, we synthesized new compounds to identify key structural features that specify recognition by AtSUC2. Our analysis of the structure-activity relationship revealed that the presence of a free hydroxyl group on the coumarin moiety is essential for binding by AtSUC2 and subsequent phloem mobility. Structural modeling of the AtSUC2 substrate-binding pocket explains some important structural requirements for the interaction of coumarin glucosides with the AtSUC2 transporter.

An integrated biorefinery concept for conversion of sugar beet pulp into value-added chemicals and pharmaceutical intermediates.

Over 8 million tonnes of sugar beet are grown annually in the UK. Sugar beet pulp (SBP) is the main by-product of sugar beet processing which is currently dried and sold as a low value animal feed. SBP is a rich source of carbohydrates, mainly in the form of cellulose and pectin, including d-glucose (Glu), l-arabinose (Ara) and d-galacturonic acid (GalAc). This work describes the technical feasibility of an integrated biorefinery concept for the fractionation of SBP and conversion of these monosaccharides into value-added products. SBP fractionation is initially carried out by steam explosion under mild conditions to yield soluble pectin and insoluble cellulose fractions. The cellulose is readily hydrolysed by cellulases to release Glu that can then be fermented by a commercial yeast strain to produce bioethanol at a high yield. The pectin fraction can be either fully hydrolysed, using physico-chemical methods, or selectively hydrolysed, using cloned arabinases and galacturonases, to yield Ara-rich and GalAc-rich streams. These monomers can be separated using either Centrifugal Partition Chromatography (CPC) or ultrafiltration into streams suitable for subsequent enzymatic upgrading. Building on our previous experience with transketolase (TK) and transaminase (TAm) enzymes, the conversion of Ara and GalAc into higher value products was explored. In particular the conversion of Ara into l-gluco-heptulose (GluHep), that has potential therapeutic applications in hypoglycaemia and cancer, using a mutant TK is described. Preliminary studies with TAm also suggest GluHep can be selectively aminated to the corresponding chiral aminopolyol. The current work is addressing the upgrading of the remaining SBP monomer, GalAc, and the modelling of the biorefinery concept to enable economic and Life Cycle Analysis (LCA).

Comparison of the BackJoy SitSmart Relief and Spine Buddy LT1 H/C Ergonomic Chair Supports on Short-Term Neck and Back Pain.

OBJECTIVE: The purpose of this study was to perform a needs assessment to determine whether short-term use of BackJoy SitSmart Relief and Spine Buddy LT1 H/C chair supports influences neck, upper back, and lower back pain. METHODS: Forty-eight college students (age, 27.5 ± 6.3 years; height, 1.72 ± 0.08 m; body mass, 78.7 ± 19.8 kg; time seated that day, 4.3 ± 2.8 hours; means ± SD) were recruited for this study. The Nordic Musculoskeletal Questionnaire was used to measure pain for the neck, upper back, and lower back regions. Subjects were randomized to sit in a stationary office chair for a single 12-minute period under 1 of 4 conditions: office chair only (control group), BackJoy SitSmart Relief and chair, freezer-cooled Spine Buddy LT1 H/C and chair, or microwave-heated Spine Buddy LT1 H/C and chair. Participants then completed a posttest Nordic Musculoskeletal Questionnaire. A between-within repeated-measures analysis of variance using the between-subject factor intervention (group) and within-subject factor time (baseline and posttest) was used to analyze study data. RESULTS: The main effect of time across the whole sample was statistically significant for neck (P = .000), upper back (P = .032), and lower back (P = .000) pain; however, there was no statistically significant interaction effect between intervention and time. Thus, as long as participants sat down and rested, symptoms improved similarly across the different groups. CONCLUSIONS: In this preliminary study, short-term and single use of a support product for an office chair had no additive effect on reducing neck and back pain.

Intratumoral heterogeneity: Role of differentiation in a potentially lethal phenotype of testicular cancer.

BACKGROUND: Intratumoral heterogeneity presents a major obstacle to the widespread implementation of precision medicine. The authors assessed the origin of intratumoral heterogeneity in nonseminomatous germ cell tumor of the testis (NSGCT) and identified distinct tumor subtypes and a potentially lethal phenotype. METHODS: In this retrospective study, all consecutive patients who had been diagnosed with an NSGCT between January 2000 and December 2010 were evaluated. The histologic makeup of primary tumors and the clinical course of disease were determined for each patient. A Fine and Gray proportional hazards regression analysis was used to determine the prognostic risk factors, and the Gray test was used to detect differences in the cumulative incidence of cancer death. In a separate prospective study, next-generation sequencing was performed on tumor samples from 9 patients to identify any actionable mutations. RESULTS: Six hundred fifteen patients were included in this study. Multivariate analysis revealed that the presence of yolk sac tumor in the primary tumor (P = .0003) was associated with an unfavorable prognosis. NSGCT could be divided into 5 subgroups. Patients in the yolk sac-seminoma subgroup had the poorest clinical outcome (P = .0015). These tumors tended to undergo somatic transformation (P < .0001). Among the 9 NSGCTs that had a yolk sac tumor phenotype, no consistent gene mutation was detected. CONCLUSIONS: The current data suggest that intratumoral heterogeneity is caused in part by differentiation of pluripotent progenitor cells. Integrated or multimodal therapy may be effective at addressing intratumoral heterogeneity and treating distinct subtypes as well as a potentially lethal phenotype of NSGCT. Cancer 2016;122:1836-43. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Attributes of Non-Hispanic Blacks That Use Chiropractic Health Care: A Survey of Patients in Texas and Louisiana.

OBJECTIVE: The purpose of this study was to describe non-Hispanic blacks that use chiropractic health care to better understand this underserved demographic. METHODS: E-mail and telephone calls were used to recruit doctors of chiropractic (DCs) in Texas and Louisiana to distribute anonymous surveys to their non-Hispanic black patients. Twenty doctors volunteered to participate. Each was sent 10 surveys and self-addressed envelopes to distribute. All doctors were given at least 3 months to distribute surveys to as many non-Hispanic black patients that they had. The survey contained 20 questions designed to develop a profile of non-Hispanic black patients that used chiropractic care. Descriptive statistics were used to summarize demographic and other patient attributes. RESULTS: Two-hundred surveys were distributed and 44 were completed, yielding a response rate of 22%. Non-Hispanic black patients were more likely to be female (54.5%), be older than 50 years (56.8%), be a college graduate (59.1%), be employed (61.9%), report not receiving public assistance in the past 5 years (81.4%), report a household income of $20 000 to $60 000 a year (48.8%), and born in the United States (83.7%). Participants reported that there was a DC within 30 minutes of their address (81.4%), their DC always explained things to them in an easy-to-understand manner (81.8%), their DC always showed respect for what they had to say (88.6%), and their DC always cared about them as a person (86.4%). CONCLUSIONS: In the sample surveyed, non-Hispanic black patients tended to be female, be older, be college educated, be employed, and have a positive viewpoint on their interactions with their DC.

Immediate effects of upper thoracic spine manipulation on hypertensive individuals.

PURPOSE: The aims of this study were to determine if there were any statistically significant immediate effects of upper thoracic spinal manipulative therapy (SMT) on cardiovascular physiology in hypertensive individuals. INTRODUCTION: Preliminary research suggests that SMT to various regions of the spine may be capable of lowering systolic and diastolic blood pressure in hypertensive individuals. Further studies are warranted to corroborate or refute these findings as well as measure how other attributes of cardiovascular physiology are impacted by SMT. METHODS: Fifty hypertensive participants (age = 45.5±13.9 years, height = 1.69±0.10 m, body mass = 93.9±21.5 kg: mean±standard deviation (SD)) were equally randomized into a single-blind, controlled trial involving two study groups: supine diversified anterior upper thoracic SMT of T1-4, or a 'no T-spine contact' control. Outcome measures were electrocardiogram, bilateral pulse oximetry, and bilateral blood pressure measurement performed at baseline, post 1-minute intervention, and post 10-minute intervention. An independent samples t-test was used to compare between-group differences at baseline. A repeated measures ANOVA was used to compare within-group changes over time. RESULTS: Within-group changes in PR interval and QRS duration demonstrated that the atria were transiently less active post-SMT and the ventricles were more active post-SMT, however the changes were clinically minimal. CONCLUSION: The results of this study, and the limited existing normotensive, thoracic-specific SMT research in this field, suggest that cardiovascular physiology, short-term, is not affected by upper thoracic spine SMT in hypertensive individuals to a clinically relevant level.

Increases in hepatitis C virus infection related to injection drug use among persons aged ≤30 years - Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012.

Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States, with approximately three million persons living with current infection. Percutaneous exposure to contaminated blood is the most efficient mode of transmission, and in the United States, injection drug use (IDU) is the primary risk factor for infection. State surveillance reports from the period 2006-2012 reveal a nationwide increase in reported cases of acute HCV infection, with the largest increases occurring east of the Mississippi River, particularly among states in central Appalachia. Demographic and behavioral data accompanying these reports show young persons (aged ≤30 years) from nonurban areas contributed to the majority of cases, with about 73% citing IDU as a principal risk factor. To better understand the increase in acute cases of HCV infection and its correlation to IDU, CDC examined surveillance data for acute case reports in conjunction with analyzing drug treatment admissions data from the Treatment Episode Data Set-Admissions (TEDS-A) among persons aged ≤30 years in four states (Kentucky, Tennessee, Virginia, and West Virginia) for the period 2006-2012. During this period, significant increases in cases of acute HCV infection were found among persons in both urban and nonurban areas, with a substantially higher incidence observed each year among persons residing in nonurban areas. During the same period, the proportion of treatment admissions for opioid dependency increased 21.1% in the four states, with a significant increase in the proportion of persons admitted who identified injecting as their main route of drug administration (an increase of 12.6%). Taken together, these increases indicate a geographic intersection among opioid abuse, drug injecting, and HCV infection in central Appalachia and underscore the need for integrated health services in substance abuse treatment settings to prevent HCV infection and ensure that those who are infected receive medical care.

Transport Function of Rice Amino Acid Permeases (AAPs).

The transport function of four rice (Oryza sativa) amino acid permeases (AAPs), OsAAP1 (Os07g04180), OsAAP3 (Os06g36180), OsAAP7 (Os05g34980) and OsAAP16 (Os12g08090), was analyzed by expression in Xenopus laevis oocytes and electrophysiology. OsAAP1, OsAAP7 and OsAAP16 functioned, similarly to Arabidopsis AAPs, as general amino acid permeases. OsAAP3 had a distinct substrate specificity compared with other rice or Arabidopsis AAPs. OsAAP3 transported the basic amino acids lysine and arginine well but selected against aromatic amino acids. The transport of basic amino acids was further analyzed for OsAAP1 and OsAAP3, and the results support the transport of both neutral and positively charged forms of basic amino acids by the rice AAPs. Cellular localization using the tandem enhanced green fluorescent protein (EGFP)-red fluorescent protein (RFP) reporter pHusion showed that OsAAP1 and OsAAP3 localized to the plasma membrane after transient expression in onion epidermal cells or stable expression in Arabidopsis.

The ergogenic effect of elastic therapeutic tape on stride and step length in fatigued runners.

OBJECTIVE: The purpose of this study was to determine if elastic therapeutic tape placed on anterior lower limbs would affect stride and step length in fatigued runners' gait. METHODS: Forty-two healthy participants were equally divided into a kinesiology tape group (Rocktape) and a no-tape control group. Participants in both groups underwent a baseline running gait test at 6 mph without tape. After this, participants engaged in an exhaustive lower body fatigue protocol until they reached maximal volitional exhaustion. Participants were then randomized to 1 of 2 interventions: (1) Experimental group, which had kinesiology tape placed under tension on the anterior aspect of their lower limbs bilaterally from the upper thigh to just below the patella, or (2) Control group, which did not receive taping. All participants then engaged in a similar 6-mph running gait postanalysis. Participant's gait was analyzed for 90 seconds during each test iteration. Researchers used a 2-way repeated-measures analysis of variance considering fatigue (prefatigue, postfatigue) and group (tape, no-tape) as subject factors. RESULTS: After the fatigue protocol, the no-tape group demonstrated a significant decrease in step length of 14.2 mm (P = .041) and stride length of 29.4 mm (P = .043). The kinesiology tape group did not demonstrate a significant decline in these gait parameters. CONCLUSIONS: In this preliminary study, placing elastic therapeutic tape over the anterior lower limbs demonstrated short-term preservation of runner step length and stride length in a fatigued state.

Effect of lumbar spine manipulation on asymptomatic cyclist sprint performance and hip flexibility.

OBJECTIVE: The purpose of this study was to measure the impact of midlumbar spinal manipulation on asymptomatic cyclist sprint performance and hip flexibility. METHODS: Twelve cyclists were equally randomized into an AB:BA crossover study design after baseline testing. Six participants were in the AB group, and 6 were in the BA group. The study involved 1 week of rest in between each of the 3 tested conditions: baseline testing (no intervention prior to testing), condition A (bilateral midlumbar spine manipulation prior to testing), and condition B (sham acupuncture prior to testing, as a control). Testing was blinded and involved a sit-and-reach test followed by a 0.5-km cycle ergometer sprint test against 4-kp resistance. Outcome measures were sit-and-reach distance, time to complete 0.5 km, maximum heart rate, and rating of perceived exertion. An additional 8 cyclists were recruited and used as a second set of controls that engaged in 3 testing sessions without any intervention to track test acclimation. An analysis of variance was used to compare dependent variables under each of the 3 conditions for the experimental group and control group #1, and a repeated-measures analysis of variance was used to analyze test acclimation in control group #2. RESULTS: Lumbar spine manipulation did not demonstrate statistically significant between-group changes in sit-and-reach (P = .765), 0.5-km sprint performance time (P = .877), maximum exercise heart rate (P = .944), or rating of perceived exertion (P = .875). CONCLUSIONS: The findings of this preliminary study showed that midlumbar spinal manipulation did not improve hip flexibility or cyclist power output of asymptomatic participants compared with an acupuncture sham and no-treatment control groups.

Pilot study of the impact that bilateral sacroiliac joint manipulation using a drop table technique has on gait parameters in asymptomatic individuals with a leg length inequality.

PURPOSE: The purpose of this study was to pilot test our study procedures and estimate parameters for sample size calculations for a randomized controlled trial to determine if bilateral sacroiliac (SI) joint manipulation affects specific gait parameters in asymptomatic individuals with a leg length inequality (LLI). METHODS: Twenty-one asymptomatic chiropractic students engaged in a baseline 90-second walking kinematic analysis using infrared Vicon® cameras. Following this, participants underwent a functional LLI test. Upon examination participants were classified as: left short leg, right short leg, or no short leg. Half of the participants in each short leg group were then randomized to receive bilateral corrective SI joint chiropractic manipulative therapy (CMT). All participants then underwent another 90-second gait analysis. Pre- versus post-intervention gait data were then analyzed within treatment groups by an individual who was blinded to participant group status. For the primary analysis, all p-values were corrected for multiple comparisons using the Bonferroni method. RESULTS: Within groups, no differences in measured gait parameters were statistically significant after correcting for multiple comparisons. CONCLUSIONS: The protocol of this study was acceptable to all subjects who were invited to participate. No participants refused randomization. Based on the data collected, we estimated that a larger main study would require 34 participants in each comparison group to detect a moderate effect size.

OBJECTIF: Le but de cette étude était de mettre à l'essai un projet pilote concernant nos procédures d'étude et d'estimer les paramètres pour le calcul de la taille de l'échantillon d'un essai contrôlé randomisé afin de déterminer si la manipulation de l'articulation sacroiliaque bilatérale affecte les paramètres spécifiques de marche chez les personnes asymptomatiques ayant un problème d'inégalité de longueur des membres inférieurs (ILMI). MÉTHODOLOGIE: Vingt et un étudiants en chiropratique asymptomatiques ont pris part à une analyse cinématique de base de la marche de 90 secondes à l'aide de caméras infrarouges ViconMD, à la suite de laquelle ils ont subi un test fonctionnel d'ILMI. Après l'examen, les participants ont été catégorisés comme suit : jambe gauche courte, jambe droite courte, pas de jambe courte. La moitié des participants de chaque groupe de « jambe courte ¼ a ensuite reçu au hasard un traitement chiropratique de manipulation de l'articulation sacro-iliaque bilatérale. Tous les participants ont ensuite pris part à une autre analyse de 90 secondes de la marche. Les données de marche avant et après l'intervention ont ensuite été analysées pour les groupes par une personne qui ne connaissait pas l'état des groupes de participants. Pour l'analyse principale, toutes les valeurs p ont été corrigées pour tenir compte des comparaisons multiples en utilisant la méthode de Bonferroni. RÉSULTATS: Au sein des groupes, aucune différence dans les paramètres mesurés de marche n'était statistiquement significative après la correction pour les comparaisons multiples. CONCLUSIONS: Le protocole de cette étude était acceptable pour tous les sujets invités à y participer. Aucun des participants n'a refusé la randomisation. En fonction des données recueillies, nous avons estimé qu'il faudrait, pour une étude principale plus importante, 34 participants dans chaque groupe de comparaison afin de détecter un effet d'une ampleur modeste.

Strength and endurance adaptations to functional electrical stimulation leg cycle ergometry in spinal cord injury.

OBJECTIVES: To describe adaptations in power output, quadriceps muscle strength, and fatigability that occur during a 13-week regimen of Functional Electrical Stimulation Leg Cycle Ergometry (FES-LCE) in Spinal Cord Injury (SCI). To identify differences in outcomes between individuals with complete and incomplete motor impairment. DESIGN: Observational and longitudinal. SETTING: Rehabilitation and biomechanics research laboratory. PARTICIPANTS: Eleven (N = 11) individuals with SCI and no previous FES-LCE experience. INTERVENTION: 40 sessions of FES-LCE at a rate of three sessions per week. Continuous exercise was performed at a pedal cadence of 45 RPM against a constant resistance for up to 60 minutes. OUTCOME MEASURES: Mean power output was recorded for each session. Before and after the training regimen, each subject performed a fatigue test in which electrically stimulated knee extension torque and Fatigue Index were measured. RESULTS: Participants demonstrated significant increases in mean power output (9.0 to 20.3 W; p < 0.001), peak isometric knee extension torque (3.8 to 16.9 Nm; p = 0.006) and sustainable isometric knee extension torque (4.9 to 14.4 Nm; p = 0.001) after FES-LCE training (95% confidence intervals). Participants with incomplete motor impairment demonstrated a decrease in Fatigue Index (p = 0.021), and improved mean power output more than those with complete motor impairment (p = 0.037). CONCLUSIONS: Significant improvements in muscle conditioning and exercise performance are possible following the 13-week regimen of FES-LCE described in this article. Individuals with incomplete motor impairment experience greater improvements in mean power output than individuals with complete motor impairment.

Immediate effects of anterior upper thoracic spine manipulation on cardiovascular response.

OBJECTIVE: The aims of this study were (1) to determine if there were statistically significant immediate effects of anterior upper thoracic chiropractic manipulative therapy on cardiovascular response in normotensive individuals and (2) to quantify responses if any were found. METHODS: Thirty-six chiropractic college students (age, 26.8 ± 4.6 years; height, 1.71 ± 0.12 m; body mass, 75.6 ± 20.0 kg; mean ± SD) were equally randomized into a single-blind, controlled trial involving 3 study groups: anterior thoracic manipulation of T1-4, Activator-based placebo manipulation, or a "no T-spine contact" control. Outcome measures were electrocardiogram, bilateral pulse oximetry, and bilateral blood pressure measurement performed at baseline, post 1-minute intervention, post 10-minute intervention, and post 24-hour (±1 hour) intervention. Between-group dependent variables were analyzed through 1-wsay analysis of variance at each of the 4 time points. Within-group dependent variables were analyzed through 2 paired-samples t tests comparing baseline to post 10 minutes and again between baseline to post 24 hours (±1 hr). RESULTS: No statistically significant difference was shown amongst any between-group or within-group cardiovascular dependent variables in this study. CONCLUSIONS: The results of this study suggest cardiovascular physiologic responses are not affected in the short term by anterior upper thoracic spine chiropractic manipulative therapy in young normotensive individuals.

Immediate effects of lower cervical spine manipulation on handgrip strength and free-throw accuracy of asymptomatic basketball players: a pilot study.

OBJECTIVE: The purpose of this pilot study was to collect preliminary information for a study to determine the immediate effects of a single unilateral chiropractic manipulation to the lower cervical spine on handgrip strength and free-throw accuracy in asymptomatic male recreational basketball players. METHODS: For this study, 24 asymptomatic male recreational right-handed basketball players (age = 26.3 ± 9.2 years, height = 1.81 ± 0.07 m, body mass = 82.6 ± 10.4 kg [mean ± SD]) underwent baseline dominant handgrip isometric strength and free-throw accuracy testing in an indoor basketball court. They were then equally randomized to receive either (1) diversified left lower cervical spine chiropractic manipulative therapy (CMT) at C5/C6 or (2) placebo CMT at C5/C6 using an Activator adjusting instrument on zero force setting. Participants then underwent posttesting of isometric handgrip strength and free-throw accuracy. A paired-samples t test was used to make within-group pre to post comparisons and between-group pre to post comparisons. RESULTS: No statistically significant difference was shown between either of the 2 basketball performance variables measured in either group. Isometric handgrip strength marginally improved by 0.7 kg (mean) in the CMT group (P = .710). Free-throw accuracy increased by 13.2% in the CMT group (P = .058). The placebo CMT group performed the same or more poorly during their second test session. CONCLUSIONS: The results of this preliminary study showed that a single lower cervical spine manipulation did not significantly impact basketball performance for this group of healthy asymptomatic participants. A slight increase in free-throw percentage was seen, which deserves further investigation. This pilot study demonstrates that a larger study to evaluate if CMT affects handgrip strength and free-throw accuracy is feasible.

Pilot study of the impact sacroiliac joint manipulation has on walking kinematics using motion analysis technology.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of engaging in a series of larger studies measuring the effect of sacroiliac joint manipulation on walking kinematics using motion analysis technology. METHODS: Twelve college students engaged in a baseline 90-second gait analysis at 1.5 mph using infrared VICON cameras. Following this, they underwent a prone heel comparison test for functional leg length inequality. Upon examination, participants were then classified as follows: left short leg, right short leg, or no short leg. Participants in each of the 2 short leg branches of this study were then randomized to receive either chiropractic manipulative therapy to the posterior superior iliac spine on the short limb side or no manipulation. Recruitment was ongoing for this pilot study until 1 participant was recruited in each of the following 5 comparative study groups: left short leg-manipulation, left short leg-no manipulation (control 1), right short leg-manipulation, right short leg-no manipulation (control 2), and no short leg (control 3). All participants then underwent another 90-second gait analysis. Data were then grouped and submitted to a blinded biomechanist to determine if there were any unique biomechanical differences between the groups. RESULTS: No statistically significant differences were measured because of this being a pilot study with a small sample size. CONCLUSIONS: The data from this study indicate that a series of larger studies with this design is feasible.