Efficacy and Adherence Rates of a Novel Community-Informed Virtual World-Based Cardiac Rehabilitation Program: Protocol for the Destination Cardiac Rehab Randomized Controlled Trial.

BACKGROUND: Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology-based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center-based CR. This study aims to evaluate efficacy and adherence of the virtual world-based CR program compared with center-based CR within a community-informed, implementation science framework. METHODS: Using a noninferiority, hybrid type 1 effectiveness-implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12-week Destination Cardiac Rehab or the center-based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board-approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. CONCLUSIONS: The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05897710.

Semi-supervised exercise training program more effective for individuals with postural orthostatic tachycardia syndrome in randomized controlled trial.

PURPOSE: Exercise like any medication requires the correct dose; to be effective the appropriate frequency, duration, and intensity are necessary. This study aimed to assess if a semi-supervised exercise training (ET) program would be more effective at improving aerobic fitness (VO2PEAK), exercise tolerance, and symptoms in individuals with postural orthostatic tachycardia syndrome (POTS) compared to the standard of care (SOC). METHODS: Subjects were randomized to either the ET or SOC groups (n 26 vs. 23; age 33 ± 11 vs. 37 ± 10 years; VO2PEAK 66 ± 15 vs. 62 ± 15% predicted, ET vs. SOC respectively, p > 0.05). Composite Autonomic Symptom Score (COMPASS 31), 10 min stand test, and cardiopulmonary exercise test were performed at baseline and following 12 weeks. The ET group received an exercise consultation and eight semi-supervised in-person or virtual exercise sessions. RESULTS: The ET group demonstrated a greater improvement in VO2PEAK, higher or longer tolerance for baseline peak workload, and more often had a delayed symptom onset with exercise than the SOC group (ΔVO2PEAK 3.4 vs. - 0.2 mL/min/kg, p < 0.0001, ΔWorkload 19 ± 17 vs. 0 ± 10 W; Workload time 63 ± 29 vs. 22 ± 30 s; onset-delay 80% vs. 30%, p < 0.05). Individuals in the ET group reported a significant improvement in orthostatic intolerance domain score (p = 0.02), but there was not a significant difference in the improvement in total COMPASS score (- 11.38 vs. - 6.49, p = 0.09). CONCLUSION: Exercise training was more effective with greater improvements in aerobic fitness, orthostatic symptoms, and exercise tolerance for individuals with POTS when intensity and progression were personalized and delivered with minimal supervision compared to the SOC.

Red osier dogwood and its use in animal nutrition: A review.

As the human population increases globally, the food animal industry has not been spared from the monumental demand for edible animal products, particularly meat. This has necessitated the simultaneous expansion of the productivity of the animal sector to meet the ever-growing human needs. Although antibiotics have been used in food animal production with commendable positive impacts on their growth performance, their sole contributive factor to the increasing incidence of antimicrobial resistance has ushered the strict restrictions placed on their use in the animal sector. This has handed a setback to both animals and farmers; thus, the intense push for a more sustainable antibiotic alternative for use in animal production. The use of plants with concentrated phytogenic compounds has gained much interest due to their beneficial bioactivities, including antioxidant and selective antimicrobial. While the reported beneficial activities of phytogenic additives on animals vary due to their varying total polyphenol concentrations (TPC), red osier dogwood (ROD) plant materials boast of high TPC with excellent antioxidant prowess and growth improvement capacities compared to some plant extracts commonly used in research. However, its adoption in research and commercial scale is still low. Thus, the present review aims to provide concise information on the dietary potential of ROD plant materials in animal feeding.

Defect-Induced, Ferroelectric-Like Switching and Adjustable Dielectric Tunability in Antiferroelectrics.

Antiferroelectrics, which undergo a field-induced phase transition to ferroelectric order that manifests as double-hysteresis polarization switching, exhibit great potential for dielectric, electromechanical, and electrothermal applications. Compared to their ferroelectric cousins, however, considerably fewer efforts have been made to understand and control antiferroelectrics. Here, it is demonstrated that the polarization switching behavior of an antiferroelectric can be strongly influenced and effectively regulated by point defects. In films of the canonical antiferroelectric PbZrO3 , decreasing oxygen pressure during deposition (and thus increasing adatom kinetic energy) causes unexpected "ferroelectric-like" polarization switching although the films remain in the expected antiferroelectric orthorhombic phase. This "ferroelectric-like" switching is correlated with the creation of bombardment-induced point-defect complexes which pin the antiferroelectric-ferroelectric phase boundaries, and thus effectively delay the phase transition under changing field. The effective pinning energy is extracted via temperature-dependent switching-kinetics studies. In turn, by controlling the concentration of defect complexes, the dielectric tunability of the PbZrO3 can be adjusted, including being able to convert between "positive" and "negative" tunability near zero field. This work reveals the important role and strong capability of defects to engineer antiferroelectrics for new performance and functionalities.

A Community-Informed Virtual World-Based Cardiac Rehabilitation Program as an Extension of Center-Based Cardiac Rehabilitation: MIXED-METHODS ANALYSIS OF A MULTICENTER PILOT STUDY.

PURPOSE: Innovative methods for delivering cardiac rehabilitation (CR) that provide strategies to circumvent the mounting barriers to traditional CR have the potential to widen access to a well-established secondary prevention strategy. Our study assesses the feasibility and acceptability of a novel virtual world-based CR (VWCR) program, Destination Rehab , as an extension of a conventional center-based CR program. METHODS: Adult cardiac patients hospitalized at Mayo Clinic hospitals with a diagnosis for CR and ≥1 modifiable, lifestyle risk factor target-sedentary lifestyle (<3 hr physical activity/wk), unhealthy diet (<5 servings fruits and vegetables/d), or current smoking (>1 yr)-were recruited. Patients participated in an 8-wk health education program using a virtual world (VW) platform from a prior proof-of-concept study and a post-intervention focus group. Primary outcome measures included feasibility and acceptability. Secondary outcome measures included changes from baseline to post-intervention in cardiovascular (CV) health behaviors and biometrics, CV health knowledge, and psychosocial factors. RESULTS: Of the 30 enrolled patients (age 59.1 ± 9.7 yr; 50% women), 93% attended ≥1 session and 71% attended ≥75% of sessions. The overall VWCR experience received an 8 rating (scale 0-10) and had high acceptability. Clinically relevant trends were noted in CV health behaviors and biometrics, although not statistically significant. CONCLUSIONS: The VWCR program is a feasible, highly acceptable, and innovative platform to potentially influence health behaviors and CV risk and may increase accessibility to disadvantaged populations with higher CV disease burdens.

Introducing Lifestyle Medicine Within the Mayo Clinic Alix School of Medicine in Arizona.

Purpose: High-value care is becoming increasingly important as the United States shifts toward a more sustainable health care system. Lifestyle medicine (LM) may be the highest-value model of care. Surprisingly, however, it is taught in a minority of medical schools. In this article, we describe a pilot project of introducing a brief LM course taught within the Mayo Clinic Alix School of Medicine in Arizona. The main purpose of the course was to introduce the students to LM as a specialty practice and to provide students with foundational knowledge of the pillars of LM. Results: Students reported improved personal health habits and increased confidence in LM competencies.

Promoting physical activity in older women to maximize health.

Physical activity can maximize health by improving disease-oriented and patient-oriented outcomes in women age 60 and older. General activity levels are low in the United States. Promoting physical activity in clinical practice is limited by time constraints and knowledge deficits. Understanding the benefits of the specific type of physical activity, the intensity, and the level in older women helps clinicians provide focused, time-efficient counseling in primary care. This review details the benefits of physical activity in older women by disease state.

Prevalence and correlates of spitting on police officers: New risks in the COVID era.

OBJECTIVES: Spitting is an occupational hazard of police work with increased risk due to the COVID-19 pandemic. We sought to calculate the prevalence of spitting on police officers in use of force incidents, as well as the demographic and situational factors associated with spitting. METHODS: Data on spitting were compiled from more than 10,000 use of force incidents occurring at 81 agencies in eight different states in the US. RESULTS: Spitting occurred in 3.6% of cases. Female and younger subjects and those using drugs and/or alcohol are more likely to spit on officers. Spitting is more likely to occur in incidents of longer duration, when officers use less force relative to subject resistance, when subjects are assaultive or engage in self-harm, and when subjects are hobbled. CONCLUSIONS: Spitting on officers is common and may now constitute a significant work hazard. Implications for police practice are discussed.

Hydrothermal extraction, a promising method for concentrating phenolic antioxidants from red osier dogwood (Cornus stolonifer) leaves and stems.

Red osier dogwood (ROD) (Cornus stolonifer) is a popular ornamental shrub in most parts of North America. It has a record of ethnopharmacological uses by native North Americans. With increasing awareness about the health benefits of natural antioxidants, efforts are needed to develop methods for producing plant-based antioxidants as sources of nutraceuticals or functional food ingredients. This study aimed at establishing an optimum temperature for hydrothermal extraction of phenolic compounds from the leaves and stems of ROD. Spray-dried extracts obtained from hydrothermal extraction at four different temperatures, as well as their raw materials and spent residue were analyzed for moisture content and water activity. The samples were extracted with organic solvent and their total phenolic content, phenolic composition and antioxidant activity were also determined. Moisture content was below 10% and the water activity was below 0.6 inclusive, which are recommended for storing dry plant products. Glucogallic acid, ellagic acid, rutin, quercetin 3-O-malonylglucoside and quercetin were the phenolic compounds identified in all the samples. Rutin was the predominant compound. As expected, all the spray-dried extracts had higher phenolic content and antioxidant activity than the raw materials and spent materials. Among the temperatures studied, 98 °C was the most effective in extracting the phenolic compounds. The spray-dried extracts may find application in high-value antioxidant-rich products such as functional food ingredients and nutraceuticals. The spent materials retained a considerable amount of phenolic antioxidants and can therefore be useful in preparing antioxidant-rich animal feed.

Effect of high versus low-velocity resistance training on muscular fitness and functional performance in older men.

This study investigated the effect of a 10-week power training (PT) program versus traditional resistance training (TRT) on functional performance, and muscular power and strength in older men. Twenty inactive volunteers (60-76 years old) were randomly assigned to a PT group (three 8-10 repetition sets performed as fast a possible at 60% of 1-RM) or a TRT group (three 8-10 repetition sets with 2-3 s contractions at 60% of 1-RM). Both groups exercised 2 days/week with the same work output. Outcomes were measured with the Rikli and Jones functional fitness test and a bench and leg press test of maximal power and strength (1-RM). Significant differences between and within groups were analyzed using a two-way analysis of variance (ANOVA). At 10 weeks there was a significantly (P < 0.05) greater improvement in measures of functional performance in the PT group. Arm curling improved by 50 versus 3% and a 30 s chair-stand improved by 43 versus 6% in the PT and TRT groups, respectively. There was also a significantly greater improvement in muscular power (P < 0.05) in the PT group. The bench press improved by 37 versus 13%, and the leg press by 31 and 8% in the PT and TRT groups, respectively. There was no significant difference between groups in improved muscular strength. It appears that in older men there may be a significantly greater improvement in functional performance and muscular power with PT versus low velocity resistance training.

Why wrestle when you can dance? Optimizing outcomes with motivational interviewing.

Motivational interviewing is a method of communication that can be effectively applied within the pharmacy setting to prompt patients toward desired behaviors. Skillful empathic listening and nonjudgmental reflections form the basis for pharmacists to encourage patients to talk about change, rather than exhibit resistance. By building rapport, pharmacists can motivate patients to resolve ambivalence about their health care behaviors and take positive action.

Motivational techniques for improving compliance with an exercise program: skills for primary care clinicians.

Motivating patients to adopt a healthful treatment plan during brief office visits is a major challenge facing health care providers. Therefore, effective communication strategies that can be successfully employed during time-pressured consultations are worthy of consideration. Traditional approaches to patient care often rely on advice-giving and direct persuasion. Motivational interviewing is an alternate style of communication that has demonstrated success with very resistant clients, such as those recovering from drug and alcohol addiction. More recent adaptations of this approach to medical settings have been effective in improving a wide range of problem behaviors, including physical inactivity. This motivational approach is well suited to the daily practice of a busy primary care clinic, where improved patient compliance is a priority. Skillful application by a clinician provides the platform for patients to talk about change instead of exhibiting resistance. Consequently, clinical consultations are not only more effective, but also less frustrating for the provider.