Physical capacity of New South Wales ambulance paramedics.

BACKGROUND: Paramedics are among the most frequently injured health professionals in Australia. A lack of physical capacity may contribute to injury risk in this occupational population. AIMS: This study sought to describe and compare the physical fitness of male and female paramedics across age groups to ascertain differences in physical capacity. METHODS: A group of regional Australian paramedics (n = 140; 78 males; mean ± SD 37.4 ± 9.9 years; body mass index 28.1 ± 4.9 kg/m2) underwent a fitness assessment. Measures included upper, lower and core-body muscular strength and flexibility. Outcomes were compared between genders and across age groups using two-way between-groups analysis of variance. RESULTS: Male paramedics had greater upper body strength (P < 0.05; push-ups) mean (95% CI): 22.6 (19.4-25.9) versus 18.7 (15.2-22.3); similar lower body strength (single-leg wall squat): 39.0 (32.6-45.3) s versus 36.7 (27.1-46.3) s; greater core strength (P < 0.05; prone plank hold): 87.9 (77.6-98.3) s versus 73.8 (63.7-83.8) s; similar upper body flexibility (back scratch): -4.0 (-6.7 to -1.3) cm versus -0.3 (-2.2 to 1.7) cm; and similar lower body flexibility (sit and reach): 20.4 (18.2-22.6) cm versus 26.1 (23.5-28.7) cm to female paramedics. Core, upper and lower body strength all decreased with age (P < 0.05). CONCLUSIONS: Core, upper and lower body strength and upper body flexibility were poorer for older compared to younger regional paramedics in New South Wales, Australia. Future research should investigate whether these outcomes are associated with occupational injury risk. This information would assist in the design of injury prevention interventions for paramedics such as tailored workplace exercise programs.

Acute electroencephalography responses during incremental exercise in those with mental illness.

Introduction: Depression is a mental illness (MI) characterized by a process of behavioral withdrawal whereby people experience symptoms including sadness, anhedonia, demotivation, sleep and appetite change, and cognitive disturbances. Frontal alpha asymmetry (FAA) differs in depressive populations and may signify affective responses, with left FAA corresponding to such aversive or withdrawal type behavior. On an acute basis, exercise is known to positively alter affect and improve depressive symptoms and this has been measured in conjunction with left FAA as a post-exercise measure. It is not yet known if these affective electroencephalography (EEG) responses to exercise occur during exercise or only after completion of an exercise bout. This study therefore aimed to measure EEG responses during exercise in those with MI. Materials and methods: Thirty one participants were allocated into one of two groups; those undergoing management of a mental health disorder (MI; N = 19); or reporting as apparently healthy (AH; N = 12). EEG responses at rest and during incremental exercise were measured at the prefrontal cortex (PFC) and the motor cortex (MC). EEG data at PFC left side (F3, F7, FP1), PFC right side (F4, F8, FP2), and MC (C3, Cz, and C4) were analyzed in line with oxygen uptake at rest, 50% of ventilatory threshold (VT) (50% VT) and at VT. Results: EEG responses increased with exercise across intensity from rest to 50% VT and to VT in all bandwidths (P < 0.05) for both groups. There were no significant differences in alpha activity responses between groups. Gamma responses in the PFC were significantly higher in MI on the left side compared to AH (P < 0.05). Conclusion: Alpha activity responses were no different between groups at rest or any exercise intensity. Therefore the alpha activity response previously shown post-exercise was not found during exercise. However, increased PFC gamma activity in the MI group adds to the body of evidence showing increased gamma can differentiate between those with and without MI.

Plasma conditions for improved energy coupling into the gain region of the Ni-like Pd transient collisional x-ray laser.

We have directly probed the conditions in which the Ni-like Pd transient collisional x-ray laser is generated and propagates by measuring the near-field image and by utilizing picosecond resolution soft x-ray laser interferometry of the preformed Pd plasma gain medium. The electron density and gain region of the plasma have been determined experimentally and are found to be in good agreement with simulations. We observe a strong dependence of the laser pump-gain medium coupling on the laser pump parameters. The most efficient coupling occurs with the formation of lower density gradients in the preformed plasma and when the duration of the main heating pulse is comparable to the gain lifetime (approximately 10 ps for mid- Z Ni-like schemes). This increases the output intensity by more than an order of magnitude relative to the commonly utilized case where the same pumping energy is delivered within a shorter heating pulse duration (<3 ps) . In contrast, the higher intensity heating pulses are observed to be absorbed at higher electron densities and in regions where steep density gradients limit the effective length of the gain medium.

Temperature determination using Kalpha spectra from M -shell Ti ions.

The compact multipulse terawatt (COMET) laser facility at LLNL was used to irradiate Al-coated 2-50 microm Ti foils with approximately 10(19) W cm(-2) , 500 fs, 3-6 J laser pulses. Laser-plasma interactions on the front side of the target generate hot electrons with sufficient energy to excite inner-shell electrons in Ti, creating Kalpha emission which has been measured using a focusing spectrometer with spatial resolution aimed at the back surface of the targets. The spatial extent of the emission varies with target thickness. The high spectral resolution (lambda/Deltalambda approximately equal to 3800) is sufficient to measure broadening of the Kalpha emission feature due to the emergence of blueshifted satellites from ionized Ti in a heated region of the target. A self-consistent-field model is used to spectroscopically diagnose thermal electron temperatures up to 40 eV in the strongly coupled Ti plasmas.

Effects of allopurinol in Duchenne's muscular dystrophy.

There is no effective treatment at present for Duchenne's muscular dystrophy (DMD). Recently, clinical improvement and increased muscle strength have been reported after 100 mg of allopurinol was administered daily to 21 boys with DMD in a double-blind crossover study. Its effectiveness was determined by an extensive battery of muscle function, cardiac, and laboratory tests. The ten-month study was divided into four periods; (1) one month of baseline observation; (2) three months of therapy to allopurinol and placebo control groups; (3) three months of therapy to crossed over groups; and (4) three months of therapy to all patients. No statistically significant changes between the allopurinol and control periods occurred in the muscle function tests. The earlier report of clinical improvement during allopurinol treatment was not confirmed.

Hospitalizations for pulmonary reactions following nitrofurantoin use.

Acute pulmonary illness compatible with previously described nitrofurantoin toxicity and requiring hospitalization occurred three times among 16,101 first courses of therapy with nitrofurantoin. One case of fatal pulmonary fibrosis was ascribed to long-term use of nitrofurantoin among 742 observed recipients of ten or more prescriptions.

Oral contraceptives and nonfatal vascular disease.

A follow-up study of more than 65,000 healthy women aged 15 to 44 was conducted to assess the association between oral contraceptive use and thromboembolism, stroke, or nonfatal myocardial infarction from 1980 through 1982 at Group Health Cooperative of Puget Sound. A positive association existed between current oral contraceptive use and venous thromboembolism (rate ratio equals 2.8), but there was no positive association between current oral contraceptive use and stroke or myocardial infarction.

First-trimester drug use and congenital disorders.

The authors determined the prevalence of certain major congenital disorders among live-born infants of 6509 mothers in a prepaid health plan for the 30-month period of January 1, 1980 through June 30, 1982 who used a wide variety of drugs during the first trimester of pregnancy. The results were similar to those obtained in this population in a prior 30-month study. No strong associations between any of the commonly used drugs and the congenital disorders studied were present.

An observational study of isotretinoin recipients treated for acne in a health maintenance organization.

From September 1982 to June 1987, all members (N = 513) of the Group Health Cooperative of Puget Sound, Seattle, Wash, who were prescribed isotretinoin for acne were observed throughout the first 4- to 5-month course of therapy for effectiveness and adverse effects. The highest rates of use were among male subjects aged 15 to 24 years. Excluding 47 subjects whose prescriptions were stopped because of noncompliance or who left the care of Group Health Cooperative physicians, 39 (8.4%) of the remaining 466 discontinued taking the drug because of the following adverse effects: mucous/skin/musculoskeletal effects (17); elevated triglyceride levels (eight); headaches (five); increased liver enzyme levels (three); amenorrhea (two); and other (four). One subject, excluded from the 466 because of noncompliance, became pregnant while using medication from a previous prescription and had a therapeutic abortion; she was not under the care of a physician at the time of pregnancy. Most subjects (97%) developed a mucocutaneous symptom, and 42% developed musculoskeletal symptoms. Moderate elevations in liver enzyme levels developed in six (1.8%) of 341 subjects with normal baseline values. Of 389 subjects with normal baseline triglyceride values (less than 2.25 mmol/L), nine (2.3%) developed moderate elevations (4.5 to 9.0 mmol/L), and one (0.3%) developed a severe elevation (greater than or equal to 9.0 mmol/L). Of 24 subjects with elevated baseline triglyceride levels, three (12.5%) developed moderate elevations. Of an additional 53 subjects whose baseline serum triglyceride levels were not determined, two developed elevations during therapy, one up to 13.4 mmol/L. Subjects who were overweight or had elevated baseline serum triglyceride values had an increased risk of developing elevations in triglyceride levels during therapy (odds ratio, 6.0; 95% confidence interval, 1.6 to 22.0; and odds ratio, 4.35; 95% confidence interval, 0.9 to 20.2, respectively). Acne was improved for at least 94.0% of subjects.

Variations in surface polymers of Streptococcus mutans.

The cell wall composition of strains of S mutans with respect to sugars and proteins appears to be correlated to the serological grouping although groups c and E are rather similar. There also appear to be similarities in the structure of the polysaccharide formed by the glycosyltransferases from organisms of serological groups b and d. However, the activity of these enzymes appears to be variable in these groups. The most noteworthy difference found was that between the three Ingbritt strains. All three strains gave identical results with regard to their cell wall composition, and presumably this would mean that they were identical serologically. However, Ingbritt LH differed considerably from both the others in the types of polysaccharide formed by their glycosyltransferases from sucrose. Ingbritt B was a reisolate from monkeys, whereas Ingbritt LH was maintained in laboratory culture, and this may explain the difference. Clearly, more work will be required to explain this difference and as c strains are commonly isolated from plaque, it would seem desirable to clear up this point.

Follow-up study of tolmetin users.

A follow-up study of 8370 outpatients who filled over 24,000 prescriptions for tolmetin revealed no hospital admissions for acute allergic, blood, skin, or central nervous system illness within 90 days of filling a prescription or refill for the drug. There were two cases of liver disease and two cases of nephrotic syndrome in which an etiologic relationship to tolmetin seemed unlikely but could not be entirely ruled out. In addition, 11 patients were hospitalized for peptic ulcer disease and its complications. In all but two patients other risk factors were present that could readily explain the illness. The rate of hospitalization for peptic ulcer disease and its complications among tolmetin recipients appears to be of the same magnitude as that in patients who take other nonsteroidal antiinflammatory drugs in this population, and close to that of the population at large.

Long-term follow-up study of cimetidine.

In a 5-year follow-up study of 8553 recipients of cimetidine at Group Health Cooperative of Puget Sound, we examined the frequency of uncommon serious illness requiring hospitalization that may have been drug induced. With the possible exception of one patient with probable drug-induced liver disease, we did not find any instances of serious illness requiring hospitalization that could be attributed with reasonable certainty to cimetidine. This large study provides reassurance that cimetidine is a relatively safe medication.

Accumulation of nifedipine after multiple doses.

The single and multiple dose pharmacokinetics of oral nifedipine capsules, 10 mg, have been examined in five patients with peripheral vasospasm. After a single dose, nifedipine was rapidly absorbed in three and slowly absorbed in two patients. Mean bioavailability parameters included a tmax of 2.9 h, a Cmax of 33.3 ng ml-1 and a AUC0-8 h of 113.3 ng h ml-1. After multiple dosing with either 10 or 20 mg every 8 h for 10 days the mean tmax at steady state was 2.1 h while the mean dose-corrected (to 10 mg) Cmax and AUC0-8 h were 51.9 ng ml-1 and 146.9 ng h ml-1, respectively. The mean elimination rate constant was 0.173 h-1 after both single and multiple doses. The mean extent of accumulation of nifedipine, defined as the ratio of AUC0-8 h (steady state)/AUC0-8 h (single dose), was 1.3; we concluded that nifedipine accumulates in the body when it is administered every 8 h. This should be taken into account when predicting steady state serum concentrations and haemodynamic effects of nifedipine from single dose kinetic data.

Predictors of MCAT scores for black Americans.

If minority students likely to score low on the Medical College Admissions Test (MCAT) can be identified in advance, they can be advised to take existing preparatory programs, or programs can be developed to meet their needs. Correlation coefficients for a number of available independent variables with MCAT scores were determined for a population of premedical students at Xavier University of Louisiana. American College Testing (ACT) and Scholastic Aptitude Test (SAT) scores were found to have similar ability to predict MCAT scores, with a correlation coefficient of 0.64 between ACT composite and MCAT total scores. Correlations of sophomore year grade point average (GPA) with MCAT scores were only slightly weaker. Use of subtest scores for the ACT and SAT, grades in science courses, and Nelson-Denny Reading Test scores did not improve prediction to any real extent, either when used alone or in multiple linear regression analysis. In contrast to some previous studies, predictions for black men were as good as those for black women. Use of only ACT composite and sophomore year GPA together gave correlations only slightly weaker than predictions using a full range of variables; data from ACT composite and sophomore year GPA can be used for calculating predictive equations on many available micro-computers. These procedures may not be applicable to minority students at majority institutions.

An assessment of a premedical program in terms of its ability to serve black Americans.

If special programs to increase the number of blacks gaining entry into health professional schools can identify whom they best serve, changes in either the selection process or the curriculum can increase their effectiveness. As one part of an evaluation of the effectiveness of the various components of the prehealth professions program at Xavier University of Louisiana (XU), black freshmen entering the university from 1981 to 1983 in the university's premedical program were tracked to determine who gained entry into medical and related mainline health professional schools upon graduation.The analyses indicate that high-ability black freshmen entering Xavier are more than twice as likely to gain admission into medical school than are their black counterparts nationally, and that this difference is statistically significant beyond the 99 percent level. Fifty-seven percent of high-ability black freshmen (those with American College Testing [ACT] composite scores of 24 or above, the top 2 percent of blacks nationally) who entered XU's biology or chemistry programs during the period under study gained entry into medical school upon graduation, whereas a study by the Educational Testing Service indicates that only 24 percent of similar blacks nationally gain entry into any graduate or professional school.The present study suggests that XU's premedical program serves those blacks who are not in the high-ability group (those whose ACT scores are below 24) at least as well (relative to the national average) as it does the top students. It therefore seems reasonable to assume that XU's premedical program is successful because it increases the probability that students gain admission into health professional schools rather than because of any preselection of students. These results are similar to those obtained from a comparable analysis of XU's prepharmacy program, the other component of prehealth at Xavier.

The direct lateral approach to the hip for arthroplasty. Advantages and complications.

The direct lateral approach to the hip as described by Hardinge in 1982 was used in the performance of 83 hip arthroplasties. This approach was found to give excellent visualization of the proximal femur and acetabulum and was found to have comparable operative time, blood loss, time to ambulation, and range of motion to other approaches. The postoperative dislocation rate was very low (2.5%) and redislocations have not occurred. The incidence of heterotopic ossification was high (61%) and this may limit the use of this approach in some cases.