Educational Intervention Changes College Students' Attitudes toward Prescription Opioid Drug Use.

Background: More than 47,000 people in the United States died from opioid drug overdoses in 2017. Among college students, opioid drugs are the second most abused drug. Objective: This study aimed to examine if an educational intervention impacted college students' attitudes towards prescription opioid drugs (POD). Methods: Two hundred forty-two participants (72 males, 21 ± 3 years) from an American university participated. After collecting demographic data (questionnaire 1; Q1), investigators recited a narrative in which the protagonist was injured and prescribed POD. Next, participants rated their agreement on 10 Likert prompts and two visual analog scales (VAS) before (Q2) and after (Q3) an educational intervention, then noted (Q4) which topics were most or least influential in any changed responses. Results: 7/10 Likert prompts (all p < 0.002) and both VAS (both p < 0.001) changed between Q2 and Q3. Educational intervention topics related to risk were most influential and topics related to alternative therapies were least influential. Conclusion/Importance: Educational interventions may be beneficial for college students. Any interventions that are employed should focus on risks associated with POD use.

Changes in Muscle Mass and Composition by Exercise and Hypoxia as Assessed by DEXA in Mice.

Background and Objective: Skeletal muscle is critical for overall health and predicts quality of life in several chronic diseases, thus quantification of muscle mass and composition is necessary to understand how interventions promote changes in muscle quality. The purpose of this investigation was to quantify changes in muscle mass and composition in two distinct pre-clinical models of changes in muscle quality using a clinical dual X-ray absorptiometry (DEXA), validated for use in mice. Materials and Methods: Adult C57Bl6 male mice were given running wheels (RUN; muscle hypertrophy) or placed in hypobaric hypoxia (HH; muscle atrophy) for four weeks. Animals received weekly DEXA and terminal collection of muscle hind limb complex (HLC) and quadriceps weights and signaling for molecular regulators of muscle mass and composition. Results: HH decreased total HLC muscle mass with no changes in muscle composition. RUN induced loss of fat mass in both the quadriceps and HLC. Molecular mediators of atrophy were upregulated in HH while stimulators of muscle growth were higher in RUN. These changes in muscle mass and composition were quantified by a clinical DEXA, which we described and validated for use in pre-clinical models. Conclusions: RUN improves muscle composition while HH promotes muscle atrophy, though changes in composition in hypoxia remain unclear. Use of the widely available clinical DEXA for use in mice enhances translational research capacity to understand the mechanisms by which atrophy and hypertrophy promote skeletal muscle and overall health.

Kinetic Analysis of Isometric Back Squats and Isometric Belt Squats.

Layer, JS, Grenz, C, Hinshaw, TJ, Smith, DT, Barrett, SF, and Dai, B. Kinetic analysis of isometric back squats and isometric belt squats. J Strength Cond Res 32(12): 3301-3309, 2018-Belt squats seem to provide an alternative to back squats. However, it is not clear how musculoskeletal loading differs between the two. This study compared lower extremity and low-back kinetics during isometric back squats and isometric belt squats. Sixteen men (age: 22.6 ± 3.4 years; height: 1.74 ± 0.11 m; mass: 82.0 ± 5.6 kg) and 10 women (age: 21.5 ± 2.5 years; height: 1.64 ± 0.10 m; mass: 68.9 ± 7.1 kg) performed isometric back squats and belt squats at 4 squat depths. Joint resultant moments were calculated from kinematic and ground reaction force data. Linear interpolation was used to estimate peak vertical forces and joint moments at a 45° thigh segment angle. Subjects increased peak forces, ankle moments, and knee moments but decreased low-back moments from back to belt squats (p ≤ 0.023). Hip moments did not significantly change between 2 squats. Subjects demonstrating smaller ankle and knee moments during back squats showed greater increases in these moments from back to belt squats (p ≤ 0.012, R ≤ 0.24). Subjects whose back squats were characterized by greater low-back moments displayed greater decreases in low-back moments from back to belt squats (p < 0.001, R = 0.98). Compared with isometric back squats, isometric belt squats may provide a similar or greater external loading for the musculoskeletal system of the lower extremities while reducing external spinal loading. Belt squats may be considered by individuals with upper-body or spinal injuries and those displaying excessive external back moments.

Effects of bioDensity Training and Power Plate Whole-Body Vibration on Strength, Balance, and Functional Independence in Older Adults.

Reduced strength, balance, and functional independence diminish quality of life and increase health care costs. Sixty adults (82.2 ± 4.9 years) were randomized to a control or three 12-week intervention groups: bioDensity (bD); Power Plate (PP) whole-body vibration (WBV); or bD+PP. bD involved one weekly 5-s maximal contraction of four muscle groups. PP involved two 5-min WBV sessions. Primary outcomes were strength, balance, and Functional Independence Measure (FIM). No groups differed initially. Strength significantly increased 22-51% for three muscle groups in bD and bD+PP (P < .001), with no changes in control and PP. Balance significantly improved in PP and bD+PP but not in control or bD. bD, PP, and bD+PP differentially improved FIM self-care and mobility. Strength improvements from weekly 5-min sessions of bD may impart health/clinical benefits. Balance and leg strength improvements suggest WBV beneficially impacts fall risk and incidence. Improved FIM scores are encouraging and justify larger controlled trials on bD and bD+PP efficacy.

Relationship Between Force Production During Isometric Squats and Knee Flexion Angles During Landing.

Decreased knee flexion angles during landing are associated with increased anterior cruciate ligament loading. The underlying mechanisms associated with decreased self-selected knee flexion angles during landing are still unclear. The purpose of this study was to establish the relationship between the peak force production at various knee flexion angles (35, 55, 70, and 90°) during isometric squats and the actual knee flexion angles that occur during landing in both men and women. A total of 18 men and 18 women recreational/collegiate athletes performed 4 isometric squats at various knee flexion angles while vertical ground reaction forces were recorded. Participants also performed a jump-landing-jump task while lower extremity kinematics were collected. For women, significant correlations were found between the peak force production at 55 and 70° of knee flexion during isometric squats and the knee flexion angle at initial contact of landing. There were also significant correlations between the peak force production at 55, 70, and 90° of knee flexion during isometric squats and the peak knee flexion angle during landing. These correlations tended to be stronger during isometric squats at greater knee flexion compared with smaller knee flexion. No significant correlations were found for men. Posture-specific strength may play an important role in determining self-selected knee flexion angles during landing for women.

The effect of interhospital transfers, emergency medical services, and distance on ischemic time in a rural ST-elevation myocardial infarction system of care.

BACKGROUND: Regional myocardial infarction systems of care have been shown to improve timely access to primary percutaneous coronary intervention (PCI). However, there is a relatively sparse research on rural "frontier" regions. Arrival mode, high rates of interhospital transfers, long transport times, low population density, and mostly volunteer emergency medical services (EMS) distinguish this region from metropolitan systems of care. We sought to assess the effect of interhospital transfers, distance, and arrival mode on total ischemic times for patients with ST-elevation myocardial infarctions undergoing primary PCI. METHODS: We assessed patient data from our observational cohort of 395 patients with ST-elevation myocardial infarction with PCI as their primary treatment strategy. Data came from the 10 PCI hospitals participating in the Wyoming Mission: Lifeline program from January 2013 to September 2014. We performed both regression and tests of differences. RESULTS: Median total ischemic time was nearly 2.7 times greater in transferred patients than those presenting directly (379 vs 140 minutes). Distance in miles traveled between patient's home and PCI facility was 2.5 times larger in transfer patients (51 vs 20 miles). Emergency medical services arrival was associated with 23% shorter total ischemic times than self-arrival. CONCLUSIONS: Transfer patients from referral hospitals had significantly greater total ischemic time, and use of EMS was associated with significantly lower times. Transport distance was mixed in its effect. These findings suggest a continued focus on improving transitions between referral and receiving centers and enhancing coordination in rural systems of care to reduce the multiplier effect of transfers on total ischemic time.

Total and Lower Extremity Lean Mass Percentage Positively Correlates With Jump Performance.

Strength and power have been identified as valuable components in both athletic performance and daily function. A major component of strength and power is the muscle mass, which can be assessed with dual-energy x-ray absorptiometry (DXA). The primary purpose of this study was to quantify the relationship between total body lean mass percentage (TBLM%) and lower extremity lean mass percentage (LELM%) and lower extremity force/power production during a countermovement jump (CMJ) in a general population. Researchers performed a DXA analysis on 40 younger participants aged 18-35 years, 28 middle-aged participants aged 36-55 years, and 34 older participants aged 56-75 years. Participants performed 3 CMJ on force platforms. Correlations revealed significant and strong relationships between TBLM% and LELM% compared with CMJ normalized peak vertical ground reaction force (p < 0.001, r = 0.59), normalized peak vertical power (p < 0.001, r = 0.73), and jump height (p < 0.001, r = 0.74) for the combined age groups. Most relationships were also strong within each age group, with some relationships being relatively weaker in the middle-aged and older groups. Minimal difference was found between correlation coefficients of TBLM% and LELM%. Coefficients of determination were all below 0.6 for the combined group, indicating that between-participant variability in CMJ measures cannot be completely explained by lean mass percentages. The findings have implications in including DXA-assessed lean mass percentage as a component for evaluating lower extremity strength and power. A paired DXA analysis and CMJ jump test may be useful for identifying neuromuscular deficits that limit performance.

Guide to the assessment of physical activity: Clinical and research applications: a scientific statement from the American Heart Association.

The deleterious health consequences of physical inactivity are vast, and they are of paramount clinical and research importance. Risk identification, benchmarks, efficacy, and evaluation of physical activity behavior change initiatives for clinicians and researchers all require a clear understanding of how to assess physical activity. In the present report, we have provided a clear rationale for the importance of assessing physical activity levels, and we have documented key concepts in understanding the different dimensions, domains, and terminology associated with physical activity measurement. The assessment methods presented allow for a greater understanding of the vast number of options available to clinicians and researchers when trying to assess physical activity levels in their patients or participants. The primary outcome desired is the main determining factor in the choice of physical activity assessment method. In combination with issues of feasibility/practicality, the availability of resources, and administration considerations, the desired outcome guides the choice of an appropriate assessment tool. The decision matrix, along with the accompanying tables, provides a mechanism for this selection that takes all of these factors into account. Clearly, the assessment method adopted and implemented will vary depending on circumstances, because there is no single best instrument appropriate for every situation. In summary, physical activity assessment should be considered a vital health measure that is tracked regularly over time. All other major modifiable cardiovascular risk factors (diabetes mellitus, hypertension, hypercholesterolemia, obesity, and smoking) are assessed routinely. Physical activity status should also be assessed regularly. Multiple physical activity assessment methods provide reasonably accurate outcome measures, with choices dependent on setting-specific resources and constraints. The present scientific statement provides a guide to allow professionals to make a goal-specific selection of a meaningful physical activity assessment method.

Elevated glucocorticoids during ovine pregnancy increase appetite and produce glucose dysregulation and adiposity in their granddaughters in response to ad libitum feeding at 1 year of age.

OBJECTIVE: Synthetic glucocorticoids (sGCs) are administered to women threatening preterm labor. We have shown multigenerational endocrine and metabolic effects of fetal sGC exposure. We hypothesized that sGC exposure would alter the second filial generation (F2) offspring neonatal leptin peak that controls development of appetitive behavior with metabolic consequences. STUDY DESIGN: F0 nulliparous ewes were bred to a single ram. Beginning at day 103 of gestation (term 150 days), dexamethasone (DEX) ewes received 4 injections of 2 mg DEX intramuscularly, 12 hours apart. Control ewes received saline. Ewes lambed naturally. At 22 months of age, F1 offspring were mated to produce F2 offspring. At 10 months of age, F2 female offspring were placed on an ad libitum feeding challenge for 12 weeks. RESULTS: DEX F2 female offspring did not show a postnatal leptin peak and their plasma cortisol concentration was elevated in the first days of life. During the feeding challenge, DEX F2 offspring consumed 10% more feed and gained 20% more weight compared with control F2 offspring. At the end of the feeding challenge, DEX F2 offspring had greater adiposity compared with control F2 offspring. F2 sGC offspring showed impaired insulin secretion in response to an intravenous glucose tolerance test. CONCLUSION: sGC administration to F0 mothers eliminates the neonatal leptin peak in F2 female offspring potentially by inhibition caused by elevated cortisol in the DEX F2 offspring. F2 offspring showed increased appetite, weight gain, and adiposity during an ad libitum feeding challenge accompanied by decreased insulin response to an intravenous glucose tolerance test.

A webcam-based machine learning approach for three-dimensional range of motion evaluation.

BACKGROUND: Joint range of motion (ROM) is an important quantitative measure for physical therapy. Commonly relying on a goniometer, accurate and reliable ROM measurement requires extensive training and practice. This, in turn, imposes a significant barrier for those who have limited in-person access to healthcare. OBJECTIVE: The current study presents and evaluates an alternative machine learning-based ROM evaluation method that could be remotely accessed via a webcam. METHODS: To evaluate its reliability, the ROM measurements for a diverse set of joints (neck, spine, and upper and lower extremities) derived using this method were compared to those obtained from a marker-based optical motion capture system. RESULTS: Data collected from 25 healthy adults demonstrated that the webcam solution exhibited high test-retest reliability, with substantial to almost perfect intraclass correlation coefficients for most joints. Compared with the marker-based system, the webcam-based system demonstrated substantial to almost perfect inter-rater reliability for some joints, and lower inter-rater reliability for other joints (e.g., shoulder flexion and elbow flexion), which could be attributed to the reduced sensitivity to joint locations at the apex of the movement. CONCLUSIONS: The proposed webcam-based method exhibited high test-retest and inter-rater reliability, making it a versatile alternative for existing ROM evaluation methods in clinical practice and the tele-implementation of physical therapy and rehabilitation.

Early maternal undernutrition programs increased feed intake, altered glucose metabolism and insulin secretion, and liver function in aged female offspring.

Insulin resistance and obesity are components of the metabolic syndrome that includes development of cardiovascular disease and diabetes with advancing age. The thrifty phenotype hypothesis suggests that offspring of poorly nourished mothers are predisposed to the various components of the metabolic syndrome due to adaptations made during fetal development. We assessed the effects of maternal nutrient restriction in early gestation on feeding behavior, insulin and glucose dynamics, body composition, and liver function in aged female offspring of ewes fed either a nutrient-restricted [NR 50% National Research Council (NRC) recommendations] or control (C: 100% NRC) diet from 28 to 78 days of gestation, after which both groups were fed at 100% of NRC from day 79 to lambing and through lactation. Female lambs born to NR and C dams were reared as a single group from weaning, and thereafter, they were fed 100% NRC recommendations until assigned to this study at 6 yr of age. These female offspring were evaluated by a frequently sampled intravenous glucose tolerance test, followed by dual-energy X-ray absorptiometry for body composition analysis prior to and after ad libitum feeding of a highly palatable pelleted diet for 11 wk with automated monitoring of feed intake (GrowSafe Systems). Aged female offspring born to NR ewes demonstrated greater and more rapid feed intake, greater body weight gain, and efficiency of gain, lower insulin sensitivity, higher insulin secretion, and greater hepatic lipid and glycogen content than offspring from C ewes. These data confirm an increased metabolic "thriftiness" of offspring born to NR mothers, which continues into advanced age, possibly predisposing these offspring to metabolic disease.

Acute Effects of Physical Exercise on Cognitive and Psychological Functioning in College Students with Attention-Deficit/Hyperactivity Disorder.

We sought to elucidate the acute effects of high-intensity interval training (HIIT) among college students with and without attention-deficit/hyperactivity disorder (ADHD). Participants were age- and sex-matched across ADHD (n = 18) and non-ADHD groups (n = 18) and both groups completed baseline (non-HIIT) and experimental sessions (HIIT). We examined within- and between-subject effects on a continuous performance task (CPT) and self-reported ADHD and internalizing symptomatology. We found that the degree of improvement on ADHD and depressive symptomatology, as well as processing speed and response variability following HIIT was significantly greater for the ADHD group than the comparison group. Further investigations such as randomized controlled trials focusing on the chronic effects of sustained HIIT interventions are needed to substantiate the potential feasibility and efficacy of HIIT as an intervention. HIIT may be a useful adjunct to psychosocial and/or pharmacological treatments for college students with ADHD because it: (a) yields immediate, acute improvements in executive functioning, ADHD, and mood; (b) promotes improved physical and mental health; (c) poses a relatively low risk of deleterious effects in apparently healthy college students. Even with the need for additional research, current data suggest a single, brief, high-intensity bout of aerobic exercise can yield immediate significant short-term improvements. These improvements may enhance functioning and improve outcomes for college students with ADHD.

Different levels of overnutrition and weight gain during pregnancy have differential effects on fetal growth and organ development.

BACKGROUND: Nearly 50% of U.S. women of child-bearing age are overweight or obese, conditions linked to offspring obesity and diabetes. METHODS: Utilizing the sheep, females were fed a highly palatable diet at two levels of overfeeding designed to induce different levels of maternal body weight increase and adiposity at conception, and from conception to midgestation. Fetal growth and organ development were then evaluated at midgestation in response to these two different levels of overfeeding. Ewes were fed to achieve: 1) normal weight gain (control, C), 2) overweight (125% of National Research Council [NRC] recommendations, OW125) or 3) obesity (150% of NRC recommendations, OB150) beginning 10 wks prior to breeding and through midgestation. Body fat % and insulin sensitivity were assessed at three points during the study: 1) diet initiation, 2) conception and 3) mid-gestation. Ewes were necropsied and fetuses recovered at mid-gestation (day 78). RESULTS: OB150 ewes had a higher % body fat than OW125 ewes prior to breeding (P = 0.03), but not at mid-gestation (P = 0.37). Insulin sensitivity decreased from diet initiation to mid-gestation (P = 0.04), and acute insulin response to glucose tended to be greater in OB150 ewes than C ewes (P = 0.09) and was greater than in OW125 ewes (P = 0.02). Fetal crown-rump length, thoracic and abdominal girths, and fetal perirenal fat were increased in the OW125 and OB150 versus C ewes at mid-gestation. However, only fetal heart, pancreas, and liver weights, as well as lipid content of fetal liver, were increased (P < 0.05) in OB150 ewes versus both C and OW125 ewes at midgestation. CONCLUSIONS: These data demonstrate that different levels of overfeeding, resulting in differing levels of maternal weight gain and adiposity prior to and during pregnancy, lead to differential effects on fetal overgrowth and organ development.

Biomechanical comparisons of back and front squats with a straight bar and four squats with a transformer bar.

The purpose was to quantify trunk and lower extremity biomechanics among back and front squats with a straight bar and four squats with different anterior-posterior load placements imposed by a transformer bar. Ten males and eight females performed six squat conditions: back and front squats with a straight bar, back and front squats with a transformer bar, and squats with more posteriorly or anteriorly placed loads with a transformer bar. A constant load of 70% of the participant's one-repetition maximum in the straight-bar front squat was used. Kinematic and kinetic data were collected to quantify joint biomechanics at an estimated parallel squat position in the descending and ascending phases. Squats with more anteriorly placed load significantly decreased trunk flexion and pelvis anterior tilt angles with large effect sizes but increased low-back extension moments with medium to large effect sizes. Hip, knee, and ankle extension moments were generally similar among most conditions. Participants adjusted their trunk and pelvis to mediate the effects of load placements on low-back and lower extremity moments. While lower extremity loading was similar among different squats, the different trunk and pelvis angles and low-back moments should be taken into consideration for people with low-back impairment.

Maternal obesity accelerates fetal pancreatic beta-cell but not alpha-cell development in sheep: prenatal consequences.

Maternal obesity affects offspring weight, body composition, and organ function, increasing diabetes and metabolic syndrome risk. We determined effects of maternal obesity and a high-energy diet on fetal pancreatic development. Sixty days prior to breeding, ewes were assigned to control [100% of National Research Council (NRC) recommendations] or obesogenic (OB; 150% NRC) diets. At 75 days gestation, OB ewes exhibited elevated insulin-to-glucose ratios at rest and during a glucose tolerance test, demonstrating insulin resistance compared with control ewes. In fetal studies, ewes ate their respective diets from 60 days before to 75 days after conception when animals were euthanized under general anesthesia. OB and control ewes increased in body weight by approximately 43% and approximately 6%, respectively, from diet initiation until necropsy. Although all organs were heavier in fetuses from OB ewes, only pancreatic weight increased as a percentage of fetal weight. Blood glucose, insulin, and cortisol were elevated in OB ewes and fetuses on day 75. Insulin-positive cells per unit pancreatic area were 50% greater in fetuses from OB ewes as a result of increased beta-cell mitoses rather than decreased programmed cell death. Lambs of OB ewes were born earlier but weighed the same as control lambs; however, their crown-to-rump length was reduced, and their fat mass was increased. We conclude that increased systemic insulin in fetuses from OB ewes results from increased glucose exposure and/or cortisol-induced accelerated fetal beta-cell maturation and may contribute to premature beta-cell function loss and predisposition to obesity and metabolic disease in offspring.

Internet-delivered lifestyle physical activity intervention: limited inflammation and antioxidant capacity efficacy in overweight adults.

Overweight and physical inactivity are associated with elevated reactive oxygen species and chronic low-grade inflammation. Exercise training studies have measured changes in systemic inflammatory and oxidative/antioxidative biomarkers but predominantly at moderate-high intensities. Few low-intensity, lifestyle-based physical activity (PA) studies have been conducted. The purpose of this study was to determine whether improvements in lifestyle-oriented PA resulting from a 16-wk Internet-delivered PA program [Active Living Every Day-Internet (ALED-I)] elicit cardioprotective improvements in measures of inflammation, oxidation, or antioxidant enzyme capacity. Forty-one men and women (age 23-62 yr) were randomized to either the ALED-I intervention [n = 19; age = 40.4 +/- 1.9 yr; body mass index (BMI) = 31.4 +/- 1.1 kg/m(2)] or a delayed intent-to-treat control condition (n = 22; age = 46.6 +/- 1.3 yr; BMI = 31.0 +/- 0.7 kg/m(2)). TNF-alpha, C-reactive protein, myeloperoxidase, superoxide dismutase, catalase, total antioxidative capacity, change in PA, and other cardiometabolic disease risk factors were measured at baseline and postintervention. The ALED-I group increased PA and decreased central adiposity without changes in the control group. There was no change in the control group for any inflammation, oxidation, or antioxidant biomarkers. TNF-alpha decreased (P = 0.01) in the intervention group but was not statistically different from the control group. In conclusion, modest improvements in daily low-intensity ambulatory PA as a result of an Internet-delivered lifestyle PA intervention may be cardioprotective in sedentary and overweight adults through reductions in central adiposity and inflammation. However, the absence of favorable changes in other inflammation, oxidation, and antioxidant biomarkers highlights the need for further attention to the dose response of lifestyle-structured PA promotion strategies for health maintenance/improvement.

Prevalence of overweight and influence of out-of-school seasonal periods on body mass index among American Indian schoolchildren.

INTRODUCTION: The prevalence of overweight and obesity among American Indian youth may be 2 to 3 times higher than the national average. Whether weight gain during discrete out-of-school periods is occurring and contributing to the prevalence of overweight and obesity in this population is unknown. METHODS: We obtained repeated cross-sectional body mass index (BMI) samples from third-, fourth-, fifth-, seventh-, and eighth-grade boys and girls who reside on the Wind River Indian Reservation in central Wyoming. We collected measures at the beginning of 2 school years (N = 251), during 2 holiday breaks (N = 226), and during 1 summer recess (N = 141). We determined prevalence of normal weight and overweight among participants by grade level, and we calculated paired comparisons of BMI, BMI z score, and weight status during the holiday breaks and summer recess. RESULTS: Combined prevalence of at risk for overweight and overweight was 62.0% for boys and 56.6% for girls. For fifth-grade girls, significant increases in BMI (P = .01) and z score (P < .001) occurred over the holiday break. BMI increased significantly over the summer among third- and fifth-grade girls and among fourth-grade boys, but changes in z scores were nonsignificant. We observed an increase in weight status by out-of-school time in BMI (P < .001) for schoolchildren at or above the 85th BMI percentile over the summer recess, but corresponding z scores did not change. CONCLUSION: Prevalence of overweight among American Indian schoolchildren was higher than national estimates and higher than the prevalence in other similarly aged American Indian youth. Increases in BMI during out-of-school periods are likely due to normal growth, except among fifth-grade girls.

Body mass index in rural first grade schoolchildren: progressive increase in boys.

CONTEXT: Childhood overweight is a global health problem. Monitoring of childhood body mass index (BMI) may help identify critical time periods during which excess body weight is accumulated. PURPOSE: To examine changes in mean BMI and the prevalence of at-risk-for overweight in repeated cross-sectional samples of rural first grade schoolchildren between 1999 and 2004. METHODS: BMI was determined in 479 first graders from a rural Wyoming school district. BMI and gender-specific BMI-for-age percentiles were determined and evaluated over the 6 years. Children were also classified as normal or at-risk-for overweight according to CDC classification procedures. FINDINGS: From 1999 to 2004, there was a significant increase in the average BMI of first graders, 15.8+/-2.2 kg/m2 versus 16.8+/-2.2 kg/m2, respectively (P<.05). First grade boys had a progressive increase in BMI from 1999 to 2004 (15.6+/-2.2 kg/m2 compared to 17.3+/-2.2 kg/m2, respectively), but no change was evident for first grade girls. There was an approximate 4-fold increase in the percentage of rural first grade boys classified as at-risk-for overweight between 1999 and 2004. CONCLUSIONS: A progressive increase in the BMI and the significant increase in prevalence of at-risk-for overweight in rural first grade boys highlight the need for future gender and age group-specific investigations. Focus should be given to primary prevention programs targeting potentially vulnerable time periods when excess weight gain may be occurring.

Four-week dynamic stretching warm-up intervention elicits longer-term performance benefits.

The purpose of this study was to determine whether a dynamic-stretching warm-up (DWU) intervention performed daily over 4 weeks positively influenced power, speed, agility, endurance, flexibility, and strength performance measures in collegiate wrestlers when compared to a static-stretching warm-up (SWU) intervention. Twenty-four male National Collegiate Athletic Association Division I wrestlers were randomly assigned to complete either a 4-week treatment condition (DWU) (n = 11) or an active control condition (SWU) (n = 13) prior to their daily preseason practices. Anthropometric and performance measures were conducted before and after the 4-week experimental period (i.e., DWU or SWU). Measures included peak torque of the quadriceps and hamstrings, medicine ball underhand throw, 300-yd shuttle, pull-ups, push-ups, sit-ups, broad jump, 600-m run, sit-and-reach test, and trunk extension test. Wrestlers completing the 4-week DWU intervention had several performance improvements, including increases in quadriceps peak torque (11%), broad jump (4%), underhand medicine ball throw (4%), sit-ups (11%), and push-ups (3%). A decrease in the average time to completion of the 300-yd shuttle (-2%) and the 600-m run (-2.4%) was suggestive of enhanced muscular strength, endurance, agility, and anaerobic capacity in the DWU group. In contrast to the DWU intervention, there was no observed improvement in the SWU group for peak torque of the quadriceps, broad jump, 300-yd shuttle run, medicine ball underhand throw for distance, sit-ups, push-ups, or 600-m run, and decrements in some performance measures occurred. The findings suggest that incorporation of this specific 4-week DWU intervention into the daily preseason training regimen of wrestlers produced longer-term or sustained power, strength, muscular endurance, anaerobic capacity, and agility performance enhancements.

Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction; however, to be effective, PCI must be performed in a timely manner. Rural regions are at a severe disadvantage, given the relatively sparse number of PCI hospitals and long transport times. METHODS AND RESULTS: We developed a standardized treatment and transfer protocol for ST-segment elevation myocardial infarction in the rural state of Wyoming. The study design compared the time-to-treatment outcomes during the pre- and postintervention periods. Details of the program, changes in reperfusion strategies over time, and outcome improvements in treatment times were reported. From January 1, 2013, to December 31, 2014, 889 patients were treated in 11 PCI-capable hospitals (4 in Wyoming, 7 in adjoining states). Given the large geographic distance in the state (median of 47 miles between patient and PCI center), 52% of all patients were transfers, and 36% were administered fibrinolysis at the referral facility. Following the intervention, there was a significant shift toward greater use of primary PCI as the dominant reperfusion strategy (from 47% to 60%, P=0.002), and the median total ischemic time from symptom onset to arterial reperfusion was decreased by 92 minutes (P<0.001). There was a similar significant reduction in median time from receiving center door to balloon of 11 minutes less than the baseline time (P<0.01). CONCLUSIONS: Rural systems of care for ST-segment elevation myocardial infarction require increased levels of cooperation between emergency medical services agencies and hospitals. This study confirms that total ischemic times can be reduced through a coordinated rural statewide initiative.