Creatine supplementation and endurance performance: surges and sprints to win the race.

Creatine supplementation is an effective ergogenic aid to augment resistance training and improve intense, short duration, intermittent performance. The effects on endurance performance are less known. The purpose of this brief narrative review is to discuss the potential mechanisms of how creatine can affect endurance performance, defined as large muscle mass activities that are cyclical in nature and are >~3 min in duration, and to highlight specific nuances within the literature. Mechanistically, creatine supplementation elevates skeletal muscle phosphocreatine (PCr) stores facilitating a greater capacity to rapidly resynthesize ATP and buffer hydrogen ion accumulation. When co-ingested with carbohydrates, creatine enhances glycogen resynthesis and content, an important fuel to support high-intensity aerobic exercise. In addition, creatine lowers inflammation and oxidative stress and has the potential to increase mitochondrial biogenesis. In contrast, creatine supplementation increases body mass, which may offset the potential positive effects, particularly in weight-bearing activities. Overall, creatine supplementation increases time to exhaustion during high-intensity endurance activities, likely due to increasing anaerobic work capacity. In terms of time trial performances, results are mixed; however, creatine supplementation appears to be more effective at improving performances that require multiple surges in intensity and/or during end spurts, which are often key race-defining moments. Given creatines ability to enhance anaerobic work capacity and performance through repeated surges in intensity, creatine supplementation may be beneficial for sports, such as cross-country skiing, mountain biking, cycling, triathlon, and for short-duration events where end-spurts are critical for performance, such as rowing, kayaking, and track cycling.

Are Caffeine's Effects on Resistance Exercise and Jumping Performance Moderated by Training Status?

This study aimed to explore if the effects of caffeine intake on resistance exercise and jumping performance are moderated by training status. We included ten resistance-trained and ten recreationally active males in a randomized, double-blind, crossover study. Participants were categorized into groups according to their resistance to training experience and muscular strength levels. Exercise performance outcomes included weight lifted and mean velocity during a one-repetition maximum (1RM) bench press and squat; repetitions were performed to muscular failure in the same exercises with 70% of 1RM and countermovement jump (CMJ) height. Exercise performance was evaluated on three occasions, following no substance ingestion (control), caffeine (6 mg/kg), and placebo. There was a main effect on the condition for all the performance outcomes (all p ≤ 0.02), except for the 1RM squat mean velocity (p = 0.157) and 1RM bench press mean velocity (p = 0.719). For weight lifted in the 1RM bench press, there was a significant difference when comparing the caffeine vs. control, caffeine vs. placebo, and placebo vs. control. For weight lifted in the 1RM squat, a significant difference was found when comparing the caffeine vs. control. For muscular endurance outcomes and jump height, a significant difference was found when caffeine was compared to the control or placebo. Effect sizes were trivial for muscular strength (Hedges' g: 0.04-0.12), small for the jump height (Hedges' g: 0.43-0.46), and large for muscular endurance (Hedges' g: 0.89-1.41). Despite these ergogenic effects, there was no significant training status × caffeine interaction in any of the analyzed outcomes. In summary, caffeine ingestion is ergogenic for muscular strength, endurance, and jump height. These effects are likely to be of a similar magnitude in resistance-trained and recreationally active men.

Assessing the Utility of Mental Health First Aid Training for Physician Assistant Students.

INTRODUCTION: Physician assistant (PA) students are at increased risk for anxiety and depression compared with the general population. The demands of studying medicine can contribute to a decline in mental health, which may impede a student's ability to progress in his or her PA program. Mental Health First Aid (MHFA) is one strategy that can be used to increase mental health literacy, promote help-seeking behavior, reduce stigma, and improve confidence in providing help to individuals showing signs of a mental health disorder. The aim of this outcomes assessment was to assess PA students' satisfaction with the MHFA course and their posttraining confidence in using the skills learned. METHODS: Participants were PA students (N = 435) across 9 PA programs in their didactic year of training who had completed an MHFA course through the PA Foundation's Mental Health Outreach Fellowship. MHFA postcourse evaluations, completed by the PA students, were analyzed to determine PA students' satisfaction with the course and their posttraining confidence in using the skills learned to help both themselves as well as the general population. RESULTS: The mean of the MHFA course evaluation items corresponding to satisfaction with the course was 4.82 (maximum score of 5), and the mean of the items corresponding to posttraining confidence in using the skills learned was 4.74 (maximum score of 5). When asked, "Would you recommend this course to others?" 99.3% of the PA students trained in MHFA answered "yes," indicating a high level of satisfaction with the training they had received. DISCUSSION: PA students who received MHFA training from the PA Foundation's Mental Health Outreach fellows showed high levels of satisfaction with the MHFA course and posttraining confidence in using the skills learned.

Comparing the Physician Assistant National Certifying Examination Pass Rate of Graduates From Programs Utilizing Distance Education to the National Average.

PURPOSE: The goal of this study was to compare the Physician Assistant National Certifying Examination (PANCE) pass rate of graduates from physician assistant (PA) programs utilizing distance education to the national average of PANCE pass rates. METHODS: The Physician Assistant Education Association online PA program directory was used to obtain the name and number of physician assistant (PA) programs that offered distance education in their curriculum. The National Commission on Certification of Physician Assistants PANCE Exam Performance Summary Report was reviewed for each PA program that offered distance education. The 5-year first-time taker mean pass rate for all PA programs offering distance education was calculated and compared to the 5-year national first-time taker average for all PA programs in the United States over the same 5-year period. RESULTS: The mean 5-year first-time taker pass rate for PA programs offering distance education was 96.9%. The 5-year national first-time taker average pass rate for all PA programs was 96.0%. CONCLUSION: The results of this study show that graduates from PA programs utilizing distance education are effectively prepared to pass the PANCE and do so at a rate that is higher than the national mean for all PA programs.

Evaluating the effectiveness of the PA Foundation's Mental Health Outreach fellowship.

OBJECTIVES: Mental Health First Aid (MHFA) is designed to help the general public acquire the knowledge and skills needed to respond to a person in a mental health emergency and offer support to someone in emotional distress. Through the PA Foundation's Mental Health Outreach Fellowship, 16 physician assistants (PAs) were selected to become MHFA instructors and teach the course to members of their local communities over 1 year. METHODS: MHFA course evaluations, completed by course participants, were reviewed to determine the effectiveness of the PA fellows as instructors. RESULTS: The fellows' mean evaluation instructor presentation score was 4.82 and the mean course content score was 4.75. The national mean for instructor presentation was 4.72 for presentation and 4.66 for course content. The maximum possible score in each category was a 5. CONCLUSIONS: The PAs selected for the Mental Health Outreach Fellowship were effective MHFA instructors. Benefits to having a PA serve as the instructor include positively affecting communities by increasing the public's mental health literacy, reducing the stigma associated with mental illness, increasing visibility and promotion of the PA profession, and enhancement of a PA's individual career through education and service.

Career regret: an analysis of physician assistants.

This article was migrated. The article was marked as recommended. Purpose: The purpose of this study was to identify life and career variables that differ between physician assistants (PAs) with and without career regret. The information in this article may be useful to PAs and PA students in their search for a professional environment that is associated with a lower risk of career regret. Methods: A survey was emailed to 5,000 PAs nationally. Aspects of their life and careers were compared between those with career regret and those without. Results: 26.9% of respondents indicated career regret. Differences were found between PAs with and without regret on the degree of schedule control, hours worked per week, salary, work-life balance, perceived burnout, career satisfaction, advice to others considering the career, and work stability. Other elements that were analyzed were not statistically significant between groups. Conclusion: Differences in work and life aspects were found when comparing PAs with and without regret. Current and future PAs may use the information from this study to help create or seek professional environments that will be less likely to lead to burnout and career regret. Employers can also utilize the information from this research study to develop or maintain work environments that protect against burnout.

Advancing Oral Health Knowledge and Attitudes of Physician Assistant Students Using the Smiles for Life Oral Health Curriculum.

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine the effectiveness of the Society of Teachers of Family Medicine's Smiles for Life: A National Oral Health Curriculum on the knowledge and attitudes of physician assistant students regarding oral health. METHODS: Seventy-two didactic year physician assistant students from one physician assistant program were surveyed to assess their knowledge and attitudes regarding oral health prior to starting the Smiles for Life oral health curriculum. The students were electronically surveyed a second time 1 week after completing all online modules in the Smiles for Life oral health curriculum. RESULTS: Precourse and postcourse survey response rates were 57% and 36%, respectively. The mean of the attitude statements increased from 3.20 on the precourse survey to 3.87 on the postcourse survey (P=.0012). The mean number of correct responses on the knowledge questions increased from 6.83 on the precourse survey to 9.85 on the postcourse survey (P<.0001). CONCLUSIONS: Statistically significant improvements in the attitudes toward oral health and oral health knowledge of physician assistant students after completion of the Smiles for Life curriculum were observed. This study illustrates the effectiveness of the Smiles for Life curriculum as an interprofessional educational experience. This curriculum can be completed online and does not require faculty expertise in oral health, thus removing previously cited barriers to incorporating oral health into the physician assistant curriculum.

Key Factors Leading to Program Selection: A Survey of Physician Assistant Program Interviewees.

PURPOSE: The purpose of this study was to determine which factors had the greatest influence on physician assistant (PA) interviewees' decision to choose a PA program to attend. The information in this article may assist PA programs in making their program more attractive to potential applicants and also may help applicants identify programs that will best fit their needs. METHODS: Applicants who interviewed with a PA program were asked to rate 33 different influential factors when choosing a program to attend. RESULTS: Respondents most highly endorsed quality of faculty and staff, first-time Physician Assistant National Certifying Examination pass rates, and morale of faculty and staff. Results varied by demographics, including marital status, age, and sex of respondent. Results also varied from pre-PA students. CONCLUSIONS: Although there are numerous factors involved in program selection, PA programs may want to focus on the quality and morale of their faculty and staff to help improve the likelihood of attracting and retaining the highest quality applicants.

Unusual case of Scedosporium apiospermum keratitis following phacoemulsification in a systemically well patient.

UNLABELLED: We report the case of a 65-year-old immunocompetent woman who developed Scedosporium apiospermum keratitis after clear-corneal phacoemulsification. A 3.5 mm by 2.7 mm full-thickness stromal infiltrate, corresponding to the superior 2.75 mm clear-corneal incision, was observed 44 days postoperatively. Treatment included preservative-free voriconazole 1.0% hourly, ofloxacin 0.3% 6 times a day, oral voriconazole 200 mg once daily, natamycin 5.0% hourly, dexamethasone 0.1% 4 times a day, and ocular cyclosporine 4 times a day. After 4 months of treatment, the new vessels had regressed, the infiltrate had disappeared, and residual deep scarring remained; the uncorrected distance visual acuity was 0.8 logMAR. To our knowledge, this is the first case of S apiospermum keratitis following clear-corneal phacoemulsification. Another unusual feature is that there were no risk factors for fungal keratitis, specifically no history of trauma, systemic illness, immunosuppression, or contact lens wear. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Do older adults' beliefs about their community mobility predict walking performance?

Among older adults, preserving community mobility (CM) is important for maintaining independent living. We explored whether perceptions of the environment and self-efficacy for CM (SE-CM) would predict walking performance for tasks reflecting CM. We hypothesized that perceptions of the environment and SE-CM would be additive predictors of walking performance on tasks reflecting the complexity of CM. Independent living older adults (N = 60) aged 64-85 completed six complex walking tasks (CWTs), SE-CM, and the environmental analysis of mobility questionnaire (EAMQ). Multiple regression analyses indicated that for each CWT, the EAMQ scales predicted walking performance (range: model R2Adj. = .078 to .139, p < .04). However, when SE-CM was added to the models, it was the sole significant predictor (p < .05). Contrary to our hypotheses, SE-CM was the best predictor in the additive models. SE-CM may be more correspondent to walking tests and thus a more sensitive predictor of CM walking performance.

Stair falls: caregiver's "missed step" as a source of childhood fractures.

BACKGROUND: The purpose of this study was to describe fractures sustained by children and to analyze the associated costs when a caretaker falls down stairs while holding a child. MATERIALS AND METHODS: Between 2004 and 2012, 16 children who sustained a fracture after a fall down stairs while being carried by a caregiver were identified. Parents/caregivers were interviewed to see how the fall occurred, and a cost analysis was performed. RESULTS: The average age of the patients was 14.5 months (7-51 months). The lower extremity was involved in 15 of 16 fractures, with 8 involving the femur. The majority were buckle fractures, but all diaphyseal femur fractures were spiral. Three patients required a reduction in the operating room. All fractures healed with cast immobilization. Five patients underwent skeletal surveys, as the treating physicians were concerned about potential child abuse. The average cost of treatment was $6785 (range $948-45,876). Detailed histories from the caregivers showed that they "missed a step" due to the child being carried in front of the caregiver, obscuring their vision. CONCLUSIONS: A fall in a caregiver's arms while going down stairs can result in multiple orthopedic injuries. The costs of treating these injuries are not insignificant, and the suspicion of child abuse can be both costly and unnecessary in the case of a true accident. While descending the stairs with a child in their arms, the caregiver should hold the child to the side so as not to obscure their vision of the step with one arm, ideally holding the handrail with the other. LEVEL OF EVIDENCE: IV case series.

Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia.

BACKGROUND: Rest-activity and sleep-wake cycles are controlled by the endogenous circadian rhythm generated by the suprachiasmatic nuclei (SCN) of the hypothalamus. Degenerative changes in the SCN appear to be a biological basis for circadian disturbances in people with dementia, and might be reversed by stimulation of the SCN by light. OBJECTIVES: The review assesses the evidence of effectiveness of light therapy in managing cognitive, sleep, functional, behavioural, or psychiatric disturbances associated with dementia. SEARCH STRATEGY: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 4 March 2008 using the terms: "bright light*", "light box*", "light visor*", "dawn-dusk*", phototherapy, "photo therapy", "light therapy" "light treatment", light* . The CDCIG Specialized Register contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources. SELECTION CRITERIA: All relevant, randomized clinical trials in which light therapy, at any intensity and duration, was compared with a control group for the effect on managing cognition, sleep, function, behavioural, or psychiatric disturbances (as well as changes in institutionalization rates or cost of care) in people with dementia of any type and degree of severity. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed the retrieved articles for relevance and methodological quality, and extracted data from the selected studies. Statistically significant differences in outcomes between the treatment and control groups at end of treatment and follow-up were examined. Each study was summarized using a measure of effect (e.g. mean difference). MAIN RESULTS: Eight trials met the inclusion criteria. However, three of the studies could not be included in the analyses because of inappropriate reported study analyses or inability to retrieve the required data from the investigators. This review revealed no adequate evidence of the effectiveness of light therapy in managing cognition, sleep, function, behaviour, or psychiatric disturbances associated with dementia. AUTHORS' CONCLUSIONS: There is insufficient evidence to assess the value of light therapy for people with dementia. Most of the available studies are not of high methodological quality and further research is required.