Critical Power, Work Capacity, and Recovery Characteristics of Team-Pursuit Cyclists.

PURPOSE: Leading a 4-km team pursuit (TP) requires high-intensity efforts above critical power (CP) that deplete riders' finite work capacity (W'), whereas riders following in the aerodynamic draft may experience some recovery due to reduced power demands. This study aimed to determine how rider ability and CP and W' measures impact TP performance and the extent to which W' can reconstitute during recovery positions in a TP race. METHODS: Three TP teams, each consisting of 4 males, completed individual performance tests to determine their CP and W'. Teams were classified based on their performance level as international (INT), national (NAT), or regional (REG). Each team performed a TP on an indoor velodrome (INT: 3:49.9; NAT: 3:56.7; and REG: 4:05.4; min:s). Ergometer-based TP simulations with an open-ended interval to exhaustion were performed to measure individual ability to reconstitute W' at 25 to 100 W below CP. RESULTS: The INT team possessed higher CP (407 [4] W) than both NAT (381 [13] W) and REG (376 [15] W) (P < .05), whereas W' was similar between teams (INT: 27.2 [2.8] kJ; NAT: 29.3 [2.4] kJ; and REG: 28.8 [1.6] kJ; P > .05). The INT team expended 104% (5%) of their initial W' during the TP and possessed faster rates of recovery than NAT and REG at 25 and 50 W below CP (P < .05). CONCLUSIONS: The CP and rate of W' reconstitution have a greater impact on TP performance than W' magnitude and can differentiate TP performance level.

IMPLEMENTATION OF ERAS PROTOCOL FOR CESAREAN SECTION.

In the past few decades, many changes have been noticed in all medical branches, especially in surgery. Enhanced Recovery After Surgery (ERAS) is a completely new approach, with the main goal to change the period of patient's recovery, making perioperative time easier and shorter. The patient's recovery is faster, better and the patient's satisfaction is bigger. Patients have an active role in their own recovery, which results in faster return to work and everyday activities. Hospital Length of Stay (LOS) is shorter and associated with concomitant financial savings. After ERAS protocol had been implemented in colorectal, abdominal surgery, urology orthopedic and oncology, and finally in obstetrics for cesarean section as well. This protocol has mostly been used in developed countries, but not in all hospitals. Creation and implementation of ERAS protocol is hard work, which includes multidisciplinary team work and especially a team leader, who coordinates the medical team, the patient and hospital management. Conclusion: Creation of an ERAS protocol is very serious and long- lasting work. It is multidisciplinary and it usually has to be individually tailored for each institution itself in coordination with the health care system and with the final implementation in the medical system.

Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia.

The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring.

Spinal Cord Trauma During Subarachnoid Anesthesia for Cesarean Delivery: A Case Report.

Spinal cord trauma can occur during subarachnoid blockade and can result in significant morbidity for the patient. Careful attention to lumbar insertion level is essential to prevent injury.

Individuals, traditions, and the righteous.

Whitehouse's article posits several plausible hypotheses, but suffers from an unwarranted reliance on the importance of distinct social groups in the causation of self-sacrificing behavior. A focus on relationships between individual kin is better able to account for both the evolution of self-sacrifice and present forms of self-sacrifice. The practical importance of this point is discussed.

Potential effects of the Afford Care Act on dentistry.

The Affordable Care Act (ACA) has the potential to reshape health care in America. The expansion of medical insurance coverage, a move toward more integrated care delivery, and significant changes to how health care is financed are some of the main changes expected. Several aspects of the ACA have important implications for dentists as oral health care professionals and small business employers, as well as consumers of medical care. While much of the effect of the ACA on health care in general and on dentistry in particular remains uncertain at this stage, it is important to highlight some of the potential changes that are likely to occur.

Continuous spinal anesthesia and analgesia in obstetrics.

The development of the technique of continuous spinal anesthesia as it relates to the obstetric population is recounted. The advantages and disadvantages of continuous spinal anesthesia are examined, currently available catheters and kits are reviewed, and strategies for the management of continuous spinal techniques for labor analgesia and surgical anesthesia are discussed. Continuous spinal anesthesia may have particular value over other regional techniques in several specific clinical circumstances.

CSF neurochemicals during tryptophan depletion in individuals with remitted depression and healthy controls.

The purpose of this study was to examine the differential effects of acute tryptophan (TRP) depletion vs. sham condition on plasma, cerebrospinal fluid (CSF) biochemical parameters, and mood in the following three subject groups: (1) nine antidepressant-free individuals with remitted depression, (2) eight paroxetine-treated individuals with recently remitted depression, and (3) seven healthy controls. Plasma TRP decreased during TRP depletion and increased during sham condition (p<.01). CSF TRP and 5-hydroxyindoleacetic acid were lower during TRP depletion than sham condition (p<.01 each). During TRP depletion, CSF TRP correlated significantly with the plasma sum of large neutral amino acids (SigmaLNAA) (R=-.52, p=.01), but did not significantly correlate with plasma TRP (R=.15, p=.52). The correlation between CSF TRP and ratio of TRP to SigmaLNAA was R=.41 and p=.06 during TRP depletion, and R=-.44 and p=.04 during sham condition. A negative correlation trend was observed between CSF-TRP levels and peak Hamilton Depression Rating Scale scores during TRP depletion in patients recovered from depression (R=-.45, p=.07), but not in healthy controls (R=-.01, p=.98). CSF neuropeptide Y was higher during TRP depletion than sham condition (t=1.75, p<.10). These results illustrate the importance of assessing plasma SigmaLNAA when using the TRP depletion paradigm. The use of a single CSF sampling technique although practical may result in data acquisition limitations.

The impact of 100 hours of exercise and sleep deprivation on cognitive function and physical capacities.

In this study, we examined the effect of 96-125 h of competitive exercise on cognitive and physical performance. Cognitive performance was assessed using the Stroop test (n = 9) before, during, and after the 2003 Southern Traverse adventure race. Strength (MVC) and strength endurance (time to failure at 70% current MVC) of the knee extensor and elbow flexor muscles were assessed before and after racing. Changes in vertical jump (n = 24) and 30-s Wingate performance (n = 27) were assessed in a different group of athletes. Complex response times were affected by the race (16% slower), although not significantly so (P = 0.18), and were dependent on exercise intensity (less so at 50% peak power output after racing). Reduction of strength (P < 0.05) of the legs (17%) and arms (11%) was equivalent (P = 0.17). Reductions in strength endurance were inconsistent (legs 18%, P = 0.09; arms 13%, P = 0.40), but were equivalent between limbs (P = 0.80). Similar reductions were observed in jump height (-8 +/- 9%, P < 0.01) and Wingate peak power (-7 +/- 15%, P = 0.04), mean power (-7 +/- 11%, P < 0.01), and end power (-10 +/- 11%, P < 0.01). We concluded that: moderate-intensity exercise may help complex decision making during sustained stress; functional performance was modestly impacted, and the upper and lower limbs were affected similarly despite being used disproportionately.

Effects of prior heavy exercise on energy supply and 4000-m cycling performance.

PURPOSE: This study was designed to determine the effects of prior exercise on energy supply and performance in a laboratory-based 4000-m time trial. METHODS: After one familiarization trial, eight well-trained cyclists (mean +/- SD; age = 30 +/- 8 yr, body mass = 78.7 +/- 8.6 kg, stature = 181 +/- 5 cm, .VO2 peak = 63.7 +/- 6.7 mL.kg.(-1)min(-1), peak power output (PPO) = 366 +/- 39 W) performed three 4000-m laboratory-based cycling time trials each preceded by one of three prior exercise regimens in randomized order: no prior exercise (control), prior heavy exercise, and self-selected prior exercise. RESULTS: Cyclists adopted a wide range of self-selected prior exercise regimens: duration ranged = 11-80 min, intensity = 48-120% PPO, and recovery = 2-11 min. Relative to control, pre-time-trial blood lactate was raised by 2.5 +/- 1.9 and 1.4 +/- 1.5 mmol.L(-1) after prior heavy and self-selected exercise, respectively. The 4000 m was completed 2.0 +/- 2.3% and 2.2 +/- 1.9% faster after prior heavy and self-selected exercise regimens, respectively, and mean power output was 5.4 +/- 3.6% and 6.0 +/- 5.8% higher, respectively. The overall aerobic contribution (.VO2) and oxygen deficit were not different between conditions (approximately 323 +/- 23 and approximately 64 +/- 22 mL.kg,(-1) respectively), although .VO2 was higher (P < 0.05) in the prior heavy (by 2.1-5.8 mL.kg(-1).min(-1)) and self-selected (2.5-4.3 mL.kg(-1).min(-1)) regimens compared with the control throughout the first half of the time trial. CONCLUSION: Very high intensity cycling performance was improved after both self-selected and prior heavy exercise. Such priming increased the early aerobic contribution but did not change overall aerobic contribution or oxygen deficit. Thus, athletes seem to manage their energy potential to exploit the available anaerobic capacity, independent of the aerobic contribution. Athletes are advised to perform a bout of heavy exercise as part of their prior exercise regimen.

Perpetrators of sexual assault continuing to have sex with their victims following the initial assault: evidence for evolved reproductive strategies.

Among a sample of college students, roughly 30% of the women and 12% of the men reported having been the victim of a sexual assault sometime in their lives. Of the assault victims, approximately 23% of both sexes stated that they had sexual intercourse with their assaulters on at least one subsequent occasion. Female victims of a completed sexual assault were significantly more likely to continue being sexually active with their assailants than were female victims who managed to block the assault, while no such difference was found for male victims. This would imply that some men are using assaultive tactics to secure sex partners beyond a single sexual episode, thereby enhancing their potential reproductive success in evolutionary terms. Also, men who committed sexual assault reported having had more lifetime sex partners than did sexually experienced men with no sexual assault history. Overall, the idea that sexual assault is part of an evolved reproductive strategy is consistent with findings from this study.

Intensity and physiological strain of competitive ultra-endurance exercise in humans.

The aim of this study was to determine the magnitude and pattern of intensity, and physiological strain, of competitive exercise performed across several days, as in adventure racing. Data were obtained from three teams of four athletes (7 males, 5 females; mean age 36 years, s = 11; cycling .VO(2 peak) 53.9 ml . kg(-1) . min(-1), s = 6.3) in an international race (2003 Southern Traverse; 96 - 116 h). Heart rates (HR) averaged 64% (95% confidence interval: +/- 4%) of heart rate range [%HRR = (HR - HR(min))/(HR(max) - HR(min)) x 100] during the first 12 h of racing, fell to 41% (+/-4%) by 24 h, and remained so thereafter. The level and pattern of heart rate were similar across teams, despite one leading and one trailing all other teams. Core temperature remained between 36.0 and 39.2 degrees C despite widely varying thermal stress. Venous samples, obtained before, during, and after the race, revealed increased neutrophil, monocyte and lymphocyte concentrations (P < 0.01), and increased plasma volume (25 +/- 10%; P < 0.01) with a stable sodium concentration. Standardized exercise tests, performed pre and post race, showed little change in the heart rate-work rate relationship (P = 0.53), but a higher perception of effort post race (P < 0.01). These results provide the first comprehensive report of physiological strain associated with adventure racing.

A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia.

BACKGROUND: Continuous intrathecal labor analgesia produces rapid analgesia or anesthesia and allows substantial flexibility in medication choice. The US Food and Drug Administration, in 1992, removed intrathecal microcatheters (27-32 gauge) from clinical use after reports of neurologic injury in nonobstetric patients. This study examined the safety and efficacy of a 28-gauge intrathecal catheter for labor analgesia in a prospective, randomized, multicenter trial. METHODS: Laboring patients were randomly assigned to continuous intrathecal analgesia with a 28-gauge catheter (n = 329) or continuous epidural analgesia with a 20-gauge catheter (n = 100), using bupivacaine and sufentanil. The primary outcome was the incidence of neurologic complications, as determined by masked neurologic examinations at 24 and 48 h postpartum, plus telephone follow-up at 7-10 and 30 days after delivery. The secondary outcomes included adequacy of labor analgesia, maternal satisfaction, and neonatal status. RESULTS: No patient had a permanent neurologic change. The continuous intrathecal analgesia patients had better early analgesia, less motor blockade, more pruritus, and higher maternal satisfaction with pain relief at 24 h postpartum. The intrathecal catheter was significantly more difficult to remove. There were no significant differences between the two groups in neonatal status, post-dural puncture headache, hemodynamic stability, or obstetric outcomes. CONCLUSIONS: Providing intrathecal labor analgesia with sufentanil and bupivacaine via a 28-gauge catheter has an incidence of neurologic complication less than 1%, and produces better initial pain relief and higher maternal satisfaction, but is associated with more technical difficulties and catheter failures compared with epidural analgesia.