Multi-Component Exercise with High-Intensity, Free-Weight, Functional Resistance Training in Pre-Frail Females: A Quasi-Experimental, Pilot Study.

BACKGROUND: No study has performed an exercise intervention that included high-intensity, free-weight, functional resistance training, and assessed frailty status as an inclusion criteria and outcome measure via original, standardized tools, in pre-frail females. OBJECTIVES: Determine if the intervention strategy is not only feasible and safe, but can also improve frailty status, functional task performance, and muscle strength. DESIGN: Pilot, quasi-experimental. SETTING: Community. PARTICIPANTS: 20 older-adults with pre-frailty characteristics. INTERVENTION: 12-weeks (3 days/week, 45-60 minutes/session) of multi-component exercise, inclusive of aerobic, resistance, balance and flexibility exercises. The crux of the program was balance and resistance exercises, the latter utilized high-intensity, free-weight, functional resistance training. The control group maintained their usual care. MEASUREMENTS: 1) Feasibility and safety (dropout, adherence, and adverse event); 2) Frailty (Frailty Phenotype, Clinical Frailty Scale, and gait speed); 3) Functional task performance (grip strength and sit-to-stand time); and 4) Isometric and isotonic strength of the knee extensors and elbow flexors. RESULTS: No participants dropped out of the intervention or experienced an adverse event, and adherence averaged 88.3%. The exercise group became less frail, whereas the control group became more frail. There was a significant within-group improvement in exercise participants gait speed (p ≤ 0.01, +0.24 m/sec), grip strength (p ≤ 0.01, +3.9 kg), and sit-to-stand time (p ≤ 0.01, -5.0 sec). There was a significant within-group improvement in exercise participants knee extension isometric torque (p ≤ 0.05, +7.4 Nm) and isotonic velocity (p = ≤ 0.01, +37.5 ˚/sec). Elbow flexion isotonic velocity significantly declined within the control group (p ≤ 0.01, -20.2 ˚/sec) and demonstrated a significant between-group difference (p ≤ 0.05, 40.73 ˚/sec) post-intervention. CONCLUSIONS: The intervention strategy appears to be feasible and safe, and may also improve frailty status, functional task performance, and muscle strength. These results help calculate effect size for a future randomized controlled trial.

Practical Implications for Strength and Conditioning of Older Pre-Frail Females.

Approaches to and benefits from resistance training for non-compromised older adults are well known. Less is understood about resistance training with pre-frail older adults, and even less information is available on the practical approaches to delivery. Herein, we describe an approach in pre-frail females who undertook a multi-component exercise intervention, inclusive of high-intensity, free-weight, functional resistance training. Capitalizing on the principle of overload is possible and safe for pre-frail females through constant reassurance of ability and adjustments in technique. Making exercise functionally relevant, for example, a squat is the ability to get on and off a toilet, resonates meaning. Older pre-frail females are affected by outside (clinical) influences. The exercise participant, and extraneous persons need to be educated on exercise approaches, to increase awareness, debunk myths, and enhance support for participation. Identification of individuality in a group session offers ability to navigate barriers for successful implementation.

Assessment of the convergent validity of the Questions About Behavioral Function scale with analogue functional analysis and the Motivation Assessment Scale.

The present study examined the convergent validity of the Questions About Behavioral Function (QABF) scale, a behavioural checklist for assessing variables maintaining aberrant behaviour, with analogue functional analyses and the Motivation Assessment Scale (MAS). The two checklists were more highly correlated with each other than either checklist with results from the analogue sessions, and the QABF was more highly correlated with analogue sessions than the MAS. Using analogue sessions, the experimenters failed to ascertain behavioural function for a number of subjects because the behaviour problems in question were low frequency/high intensity and failed to appear during the course of the analysis, pointing out a limitation of this technology. These findings, taken together with recent research outlining the psychometric properties of the QABF, seem to support the use of the QABF in a hierarchical model of functional analysis. The implications of the findings are discussed.

Evaluating the predictive validity of a single stimulus engagement preference assessment.

Most preference assessments require individuals to choose among two or more stimuli. More recently, the duration of engagement with items has been used as an index of preference. In the current study, the predictive validity of a single stimulus engagement (SSE) preference assessment was evaluated with 4 individuals. Stimuli were presented singly for a brief period while engagement with that stimulus was recorded. Although SSE preference rankings closely matched paired stimulus preference assessment rankings for only 2 of the 4 participants, relative preference rankings based on duration of engagement predicted relative reinforcer effectiveness for all participants in a subsequent concurrent-schedule reinforcer assessment. The SSE procedure took less time to administer than the paired stimulus procedure but produced less stable preference rankings across administrations. The SSE procedure may be appropriate for individuals who have difficulty selecting one stimulus from among two or more stimuli, and it may be well suited for evaluating activities that are difficult to present in a paired stimulus format.

Questions about behavioral function (QABF): a behavioral checklist for functional assessment of aberrant behavior.

Functional assessment is a method to identify the relationships between a behavior of interest and an individual's environment. Traditional methods for functional assessment have relied on experimental techniques in which analog sessions are designed to replicate conditions in the individual's environment. However, these techniques can be time-consuming, require advanced training, and rely on the availability of extensive resources in the individual's setting. Development of a brief functional assessment checklist would circumvent these difficulties and meet clinical needs for efficient assessment methods. The current study provides psychometric data for the Questions About Behavioral Function. These data include test-retest, inter-rater, and internal consistency.

Factor structure of the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER).

OBJECTIVE: A factor analysis of the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER) was conducted to determine if there was an underlying factor structure which supported a distinction between positive and negative social skills. DESIGN: Principal Axis Factoring with oblimin rotation was used to determine if a two-factor solution was valid. This method was selected to account for shared variance between the items and for correlation between the factors. METHOD: The MESSIER was administered by trained staff to 805 individuals with severe and profound intellectual disability residing in a state residential facility. RESULTS: Results of the factor analysis yielded two categories (positive and negative behaviours) that corresponded to the general division of the clinically derived subscales. CONCLUSIONS: The psychometric research on the MESSIER was extended with an examination of the factor structure. The results of the factor analysis, corresponding with the general division of the clinically derived subscales, are promising. Future research should be conducted to determine if factor scores can be used to determine norms.

Characteristics of depression as assessed by the Diagnostic Assessment for the Severely Handicapped-II (DASH-II).

Fifty-seven individuals with severe and profound mental retardation (18 with a DSM-IV diagnosis of depression, 19 with a Diagnostic Statistical Manual, 4th edition diagnosis of autism, and 20 who meet no criteria for an emotional disorder) were studied. The validity of the Diagnostic Assessment for the Severely Handicapped II depression subscale was evaluated to determine its value in categorizing individuals in these two groups. Suggestions were made for diagnosing depression in persons with severe and profound mental retardation. In a second study the above individuals were compared on symptomology to assess comorbidity with related symptoms. These "core," peripheral, or associated features of depression were identified. Implications of the findings for describing and defining depression in these persons are discussed.

Haemophilus influenzae type b conjugate vaccine stability: catalytic depolymerization of PRP in the presence of aluminum hydroxide.

The structural stability of the Haemophilus influenzae type b (Hib) capsular polysaccharide, polyribosylribitolphosphate (PRP) in an aluminum hydroxide adsorbed, polysaccharide-protein conjugate vaccine was monitored using modifications of an HPLC assay developed by Tsai et al. [Tsai C-M, Gu X-X, Byrd RA. Quantification of polysaccharide in Haemophilus influenzae type b conjugate and polysaccharide vaccines by high-performance anion-exchange chromatography with pulsed amperometric detection. Vaccine 1993;12:700-706.]. As applied to products containing PRP conjugated to the outer membrane protein complex (OMPC) from Neisseria meningitidis, this assay allows direct measurement of the total PRP content in very complex samples including commercial vaccine products. In addition, with the use of a high-speed centrifugation step, the assay can be used to directly quantify any PRP that is not conjugated to the OMPC carrier protein. These results provide evidence of what appears to be a catalytic reaction taking place between the phosphodiester bond of PRP and the aluminum hydroxide adjuvant that results in hydrolysis of the PRP polymer into smaller chain lengths and liberation of PRP oligomers from the conjugate particle. The reaction approaches an asymptotic limit after approximately two years at 2-8 degrees C. Clinical studies which span this time period confirm that the modest decrease in conjugated PRP content over time does not impact the overall clinical effectiveness of PRP-OMPC-containing vaccines.

An analysis of elderly clients' views of mobility.

This article presents findings from part of a larger qualitative study designed to explore the concept of mobility within the context of concept development. Primary nurses and their elderly clients made up the two study samples. Data were collected through semistructured interviews and analyzed using thematic content-analysis techniques. In this article, only data from the client sample are reported. Findings suggested that the elderly clients defined mobility in terms of three interrelated dimensions: physical, cognitive, and social. From client descriptions of mobility, six qualities emerged: ease and freedom of movement, independence, automaticity, purposefulness, self-environmental awareness, and continuity.

Health promotion ideology and nursing education.

Nursing has been concerned primarily with the visible aspects of health promotion and has shown little regard for what is invisible. Yet the hidden ideology powerfully shapes current approaches to health promotion. This paper examines and makes visible the ideology of individual responsibility which is embedded in individualistic health promotion, the primary orientation to health promotion. Ways in which this ideology is perpetuated within nursing curricula are described. Concrete strategies are proposed that may be considered by nurse educators as they seek to prepare students in health promotion, with particular emphasis on strategies that highlight its ideological underpinnings.

Mobility aids and the elderly client.

As life expectancy increases, nurses working with elderly clients will continue to be challenged to maintain mobility, particularly in clients with chronic illness. Because of this, it is important to have research-based strategies to assist clients. Currently there is a dearth of nursing related research in the area of mobility and mobility aids. The findings from this study may provide the impetus for re-examining the concept of mobility, and its underlying assumptions as foundational to nursing practice.

A study of nurses' perceptions of client mobility.

This paper is part of a larger study to examine the concept of mobility from the perspectives of clients and nurses. It represents a beginning effort at clarifying, refining, and developing the concept for nursing practice as the current literature concentrates on immobility. The enquiry began with a theoretical phase during which attributes and characteristics of the concept were elicited. This was followed by a fieldwork phase to determine whether there was congruency between the theoretical formulations of the concept and empirical data. Primary nurses and their clients were interviewed and data were analyzed using content analysis. In this article, only data obtained from the nurse population are reported. Themes derived from the nurses' interviews are described and compared with the results of the theoretical phase. Findings revealed that there was a measure of support for the concept as defined in the theoretical phase but pointed to the need for more empirical work with different client populations across settings.

Patient factors and central line infection.

The purpose of this prospective study was to examine the relationship between patient-related factors and the development of central venous catheter infection. Fifty-three patients, representing 64 central lines, were followed from catheter insertion to removal. Information about the patient's age, sex, immunocompetence status, central line characteristics, medication regimen, and laboratory results was obtained. Results showed that, of these factors, only the medication regimen was a promising predictor of infection status. Patients who were receiving antibiotics during central line catheterization were at less risk of developing infection than patients who were not receiving them.

The poster assignment: a connected teaching strategy for increasing student comfort with issues of sexuality.

The poster assignment has proven to be the most successful strategy designed by a group of nurse educators seeking to facilitate nursing student comfort and confidence with sexuality related content. Through the use of a process involving both structured and informal interaction opportunities, the context was set for students to build knowledge, examine values and attitudes, and develop helping skills, necessary building blocks for preparing students to assist patients with sexual problems and concerns. The process is described and discussed with specific examples given from the authors' experiences with this non-traditional learning activity.

Energy balance of nutrition and activity in a group of nursing students.

This descriptive study presents a profile of energy balance, nutrition, and activity in a group of baccalaureate nursing students (N = 21). Self-reported, consecutive, three-day food and physical activity records as well as a background questionnaire served as the instruments for data collection. Findings revealed that energy intakes were adequate to meet recommended nutrient intakes for all nutrients except carbohydrate, but insufficient to meet their levels of energy expenditure. Student involvement in a range of activities that required substantial energy expenditure, coupled with weight-loss dieting by several students appear to explain this observed energy imbalance. Increased carbohydrate intake and decreased fat intake would seem to be recommended nutritional modifications warranted for this group of nursing students.

Mobility: a concept analysis.

In this paper, the authors present their analysis of the concept of mobility as a starting point for the development of relevant theory. Multiple uses of the concept are considered and provisional criteria identified. Case examples, together with antecedents and consequences, of the concept are presented. Finally, research questions that would form the basis of fieldwork have been generated.

Corticosterone does not cause testicular toxicopathology in the rat: relevance to methylxanthines, ACTH and stress.

1. Methylxanthines, ACTH and stress are well known to produce testicular pathology (e.g. seminiferous tubule atrophy). Methylxanthines, ACTH and stress alter hormone secretion, particularly from the pituitary-adrenocortical system. Consequently, it has recently been suggested that there may be a causal relationship between changes in endogenous physiological adrenocortical secretions, particularly corticosterone, and testicular pathology. 2. This study tested the hypothesis that corticosterone mediates the testicular effects of both methylxanthine treatment and stress. Corticosterone was administered daily by subcutaneous injection to groups of 10 male rats at dose levels of 2 or 20 mg kg-1 in propylene glycol (1 ml kg-1) for 1 month (the shortest duration of methylxanthine or ACTH exposure known to produce testicular pathology). The highest dose of corticosterone resulted in plasma concentrations that closely matched values resulting from stress (200-700 ng ml-1) compared with controls (< 25 ng ml-1). 3. The highest dose of corticosterone caused reduced body weight gain, lower thymus, adrenal, seminal vesicle and prostate weights, but did not induce any testicular pathology. 4. That a high, but physiologically relevant, dose of corticosterone did not cause testicular pathology in this experiment excludes this steroid in the direct aetiology of methylxanthine, ACTH and stress-induced testicular pathology. Other steroids secreted from the adrenal, in combination with corticosterone, may be involved.

Corticosterone-independent alteration of lymphocyte mitogenic function by amphetamine.

Amphetamine, a neural stimulatory agent with acute effects mimicking those of stress, is shown here to elevate plasma corticosterone levels and suppress spleen and peripheral blood lymphocyte (PBL) mitogenic responses to concanavalin A (Con A) and phytohemagglutinin (PHA) when administered to rats. Pretreatment of the rats with propranolol, a nonselective beta-adrenergic receptor antagonist, totally prevented the amphetamine-induced suppression of lymphocyte mitogenic reactivity to Con A and PHA in the spleen and to PHA in the peripheral blood; however, the PBL mitogenic response to Con A was only partially restored. Although the amphetamine-induced alterations in immune function were prevented by propranolol pretreatment, the elevated plasma corticosterone response was not. This suggests that corticosterone is not modulating the mitogenic activity of splenic lymphocytes or PHA-reactive PBLs. On the other hand, Con A-reactive PBLs may be affected by corticosterone and/or other mechanisms, which may include the catecholamines.

A synthesis of selected literature on mobility: a basis for studying impaired mobility.

The concept of mobility can be found in the nursing diagnosis literature as impaired physical mobility, which is generally defined as limitations of physical movement within the environment. In this context, mobility is viewed within the confines of the physical realm. This conceptualization is restrictive in scope and therefore does not provide much direction for the nurse clinician. The theoretical basis of mobility must be strengthened to generate the knowledge necessary to understand impaired physical mobility. The purpose of this article is to present a consolidated review of the literature related to the concept of mobility. Studies from the social sciences are explored. Conceptual orientations from the health literature also are discussed. Finally, the nursing perspective is examined, including the measurement of the concept.

Faculty development: the essence of curriculum development.

For years, nurse educators' approach to curriculum building has been one entrenched in the behaviourist school of thinking. The outcome for nursing was a graduate who could function well in a predictable environment. However, as nursing practice is becoming increasingly complex, nurse educators feel more and more disenchanted with this approach and are turning to orientations which support a professional model of education. Shifting orientation to a paradigm for professional education requires that educators change their views and practices to reflect the assumptions underlying the new paradigm. This paper examines the process involved in shifting orientations to curriculum development and proposes strategies to mobilise educators in their own resocialisation to their new roles as educators and learners.