Chronic leptin administration increases insulin-stimulated skeletal muscle glucose uptake and transport.

Leptin, the product of the ob gene, has been shown to reduce fat mass, food intake, hyperglycemia, and hyperinsulinemia and to increase whole-body glucose disposal. However, it is unknown if leptin improves insulin action in skeletal muscle. Therefore, the purpose of this investigation was to determine if chronic leptin administration increases insulin-stimulated skeletal muscle glucose uptake and transport. Sixty-nine female Sprague-Dawley rats (240 to 250 g) were randomly assigned to one of three groups: (1) control, (2) pair-fed, and (3) leptin. All animals were subcutaneously implanted with miniosmotic pumps that delivered 0.5 mg leptin/kg/d to the leptin animals and vehicle to the control and pair-fed animals for 14 days. Following this 14-day period, all animals were subjected to hindlimb perfusion to determine the rates of skeletal muscle glucose uptake and 3-O-methyl-D-glucose (3-MG) transport under basal, submaximal (500 microU/mL), and maximal (10,000 microU/mL) insulin concentrations. Chronic leptin treatment significantly increased (P < .05) the rate of glucose uptake across the hindlimb by 27%, 32%, and 47% under basal, submaximal, and maximal insulin, respectively, compared with the control and pair-fed condition. However, when the submaximal rate of glucose uptake was expressed as a percentage of maximal insulin-stimulated glucose uptake, no differences existed among the groups, indicating that leptin treatment does not increase insulin sensitivity. Rates of 3-MG transport in the soleus, plantaris, and white and red portions of the gastrocnemius (WG and RG) were significantly increased (P < .05) in leptin animals under all perfusion conditions. 3-MG transport was not different between control and pair-fed animals. Collectively, these findings suggest that improvements in insulin-stimulated skeletal muscle glucose uptake and transport following chronic leptin treatment result from increased insulin responsiveness.

A physiological comparison of forward vs reverse wheelchair ergometry.

The purpose of this study was to compare metabolic and cardiopulmonary responses for forward wheelchair ergometry (FOR) and reverse wheelchair ergometry (REV) at equal power outputs (PO) levels. Moderately active able-bodies (N = 21) subjects exercised at 3-min stages at PO levels of 15, 20, 25, and 30 W for each mode of ergometry. Oxygen uptake (VO2), pulmonary ventilation (VE), respiratory exchange ratio (RER), heart rate (HR), percent net mechanical efficiency (ME), revolutions per minute (RPM) and strikes per minute (SPM) were determined at each PO level. With the exception of RER, all the physiological responses (VO2, VE, and HR) were higher for FOR exercise (P < 0.05) than REV exercise. ME increased with PO and was higher (P < 0.05) for REV than FOR at each PO level. SPM values for the REV were lower (P < 0.01) by almost half of that for the FOR exercise, although RPM remained constant between modes during all four stages. In general, these data suggest that reverse wheelchair ergometry is physiologically more efficient than conventional wheelchair ergometry and should be studied further as an alternative method for wheelchair ambulation.

Effects of stairclimbing on VO2max and quadriceps strength in middle-aged females.

The purpose of this study was to determine the effect of 12 wk of stairclimbing with and without an external load on aerobic capacity and quadriceps strength of sedentary (initial VO2max 25.3 +/- 0.73 ml.kg-1.min-1) (mean +/- SEM) middle aged females (50-65 yr). Three groups, LOAD (stairclimbing with external load, N = 8), STAIR (no load, N = 9), and CONTROL (N = 7) were tested. By week 4, subjects warmed up 5 min on a cycle ergometer followed by 35 min on the stairclimber at 80-85% maximum heart rate (MHR) 4 d.wk-1. In week 6, the LOAD group carried an external load of 4% of body weight increasing to 8% for weeks 7-12. STAIR and LOAD group significantly increased (P < 0.01) VO2max by 11.1% and 9.6%, respectively. Isokinetic strength tests showed increased (P < 0.05) peak torque and total work for STAIR and LOAD at 120 and 180 degrees.s-1. For total work, a significant increase (P < 0.05) of 10.5% was observed at 60 degrees.s-1 for the LOAD group. The results indicate stairclimbing is an appropriate exercise for middle-aged females improving both aerobic capacity and strength following 12 wk of training.

Effect of run vs combined cycle/run training on VO2max and running performance.

The effects of 5 wk of equivalent intensity, 85-90% maximum heart rate (MHR), run-only (N = 6) vs cycle/run (N = 5) training were evaluated in moderately fit runners, mean VO2max of 55.2 ml.kg-1.min-1, 19-35 yr old, on maximal treadmill (TM) and cycle ergometer (CE) testing, 5000-m and 1609-m run performances, and submaximal measures while treadmill running. Subjects participated in either 4 d.wk-1 of run-only or alternating run and cycle training. Both groups significantly improved TM VO2max (P < 0.05), CE VO2peak (P < 0.01), and 5000-m (P < 0.01) and 1609-m (P < 0.05) run times with no significant differences between the groups. The TM VO2max pre/post values were 55.3 +/- 3.0 to 58.2 +/- 3.0 and 55.6 +/- 3.8 to 58.9 +/- 2.4 ml.kg-1.min-1 for the run group and cross-trained group, respectively. Posttraining submaximal treadmill running showed statistically significant pace increases of 18.7 (run) and 16.1 (cycle/run) m.min-1 with similar heart rate, blood lactate, and RQ values as pretraining. Results indicate that 5 wk of either mode of training can significantly improve aerobic capacity and run performance.

Effects of stair-climbing vs run training on treadmill and track running performance.

Physically active college age women were evaluated to determine the effects of 9 wk of stair-climbing (Stairmaster Gauntlet) vs run training on 2414-m run time and treadmill measured aerobic capacity (VO2max) and submaximal physiological parameters. Subjects were randomly assigned to a stair-climbing (STAIR N = 11) (43.8 +/- 1.5 ml.kg-1.min-1) (mean +/- SEM) or run training (RUN N = 12) (44.2 +/- 1.8) group, training 4 d.wk-1 at 70-80% of maximum heart rate (MHR) for 30 min progressing to 85-90% MHR for 45 min. The STAIR group significantly increased (P < 0.01) their VO2max by 12% and decreased (P < 0.01) their 2414-m run time of 12.8 min by 8%. The RUN group increased (P < 0.01) their VO2max 16% and decreased run time (P < 0.01) 11% from 13.1 min. Submaximal treadmill runs at the same speed and grade demonstrated significant decreases in %VO2max and % MHR (P < 0.01) for both groups. The data support the use of stair-climbing exercise as an alternative mode to running with similar treadmill and running performance results subsequent to 9 wk of training.

The use of CPAP in patients with refractory epilepsy.

Four patients, diagnosed with refractory epilepsy, were treated with both continuous positive airway pressure (CPAP) and antiepileptic medication (AEM) and showed > 50% reduction in seizures after 6 months-2 years follow-up. Two patients subsequently had AEM withdrawn and are seizure free and in one such patient, obstructive sleep apnoea (OSA) has remained the only operative diagnosis. This dual approach to care provided a real advantage to the management of patients with the dual diagnoses of OSA and epilepsy, which was refractory to standard AEM therapy.

Interface of epilepsy and sleep disorders.

Obstructive sleep apnoea was first brought to prominence by Henri Gastaut, a French epileptologist. Since that time the interface between epilepsy and sleep disorders has received less attention than might be justified, recognizing that sleep deprivation is a poignant provocateur for seizures. Sleep deprivation is often used as a diagnostic procedure during electroencephalography (EEG) when waking EEG has failed to demonstrate abnormality. Patients referred to an outpatient neurological clinic for evaluation of possible seizures in whom sleep disorder was suspected, either due to snoring during the EEG or based on history, were evaluated with all-night diagnostic polysomnography (PSG) and appropriate intervention administered as indicated. Patient and seizure demography, sleep disorder and response to therapy were reviewed and the interface explored. Fifty patients aged between 10 and 83 years underwent PSG. Approximately half were diagnosed with epilepsy and almost three-quarters had sleep disorders sufficiently intrusive to require therapy (either continuous positive air pressure (CPAP) or medication). With co-existence of epilepsy and sleep disorders, proper management of sleep disorders provided significant benefit for seizure control. Snoring during EEG recordings could alert to the possibility of a sleep disorder even with epilepsy diagnosed. Where both epilepsy and sleep disorder coexist appropriate management of the sleep disorder improves control of the epilepsy.

Relationship of Body Core Temperature and Warm-up to Knee Range of Motion.

This study examined the effects of submaximal, treadmill exercise-induced body core temperature (BCT) increase on selected knee range of motion (ROM). Twenty males, 18-35 years old, were tested (randomized crossover) for ROM, BCT, and heart rate (HR), followed by either Treatment I (20 minutes of rest) or Treatment II (20 minutes of submaximal running). The two treatments were subsequently followed by a two-minute passive stretch. Range of motion was assessed before and after passive stretch treatment intervention. Treatment means differed for BCT and HR (p < 0.001) but not for ROM after exercise intervention. It was concluded that 20 minutes of exercise increased BCT (>1 degrees C) but had no effect on knee ROM. J Orthop Sports Phys Ther 1991;13(3):126-131.

Treadmill vs Steptreadmill Ergometry.

In brief: Eighteen college students were tested in five stages on both a treadmill and a revolving stair ergometer. The researchers found no significant differences in peak responses between the two modes-as measured by oxygen consumption, heart rate, ventilation, respiratory exchange ratio, and work time. However, during submaximal exercise in stages I and II, the values for heart rate and oxygen consumption were higher for stair-climbing subjects than for treadmill subjects. These findings support the use of revolving stair ergometers for testing and/or training healthy young adults.

Changes in tropical cyclone number, duration, and intensity in a warming environment.

We examined the number of tropical cyclones and cyclone days as well as tropical cyclone intensity over the past 35 years, in an environment of increasing sea surface temperature. A large increase was seen in the number and proportion of hurricanes reaching categories 4 and 5. The largest increase occurred in the North Pacific, Indian, and Southwest Pacific Oceans, and the smallest percentage increase occurred in the North Atlantic Ocean. These increases have taken place while the number of cyclones and cyclone days has decreased in all basins except the North Atlantic during the past decade.

A checklist for planning and designing audiovisual facilities in health sciences libraries.

Developed by an MLA/HeSCA (Health Sciences Communications Association) joint committee, this checklist is intended to serve as a conceptual framework for planning a new or renovated audiovisual facility in a health sciences library. Emphasis is placed on the philosophical and organizational decisions that must be made about an audiovisual facility before the technical or spatial decisions can be wisely made. Specific standards for facilities or equipment are not included. The first section focuses on health sciences library settings. Ideas presented in the remaining sections could apply to academic learning resource center environments as well. A bibliography relating to all aspects of audiovisual facilities planning and design is included with references to specific sections of the checklist.

Results of a nationwide Veterans Affairs initiative to align graduate medical education and patient care.

CONTEXT: Planning for the US physician workforce is imprecise. Prevailing policy generally advocates more training in primary care specialties. OBJECTIVE: To describe a program to increase primary care graduate medical education (GME) in a large academic health system-the Veterans Health Administration of the Department of Veterans Affairs (VA). DESIGN: In 1995, a VA advisory panel recommended a 3-year plan to eliminate 1000 specialist training positions and add 750 primary care positions. After assessing the impact of the first year of these changes on patient care, the VA implemented modifications aimed at introducing primary care curricula for training of internal medicine subspecialists, neurologists, and psychiatrists. The change in strategy was in response to the call for better alignment of GME with local patient care and training needs to provide coordinated, continuous care for seriously and chronically ill patients. SETTING: The VA health system, including 172 hospitals, 773 ambulatory and community-based clinics, 206 counseling centers, and 132 nursing homes. PARTICIPANTS: A total of 8900 VA residency training positions affiliated with 107 medical schools. MAIN OUTCOME MEASURE: Proportion of residents in primary care training during the 3-year alignment. RESULTS: Over 3 years, primary care training in the VA increased from 38% to 48% of funded positions. Of this total, 39% of the increase was in internal medicine subspecialties, neurology, and psychiatry. CONCLUSION: In this case study of GME realignment, national policy was driven more by local patient care issues than by a perceived national need for primary care or specialty positions.

Functional and locomotive characteristics of stroke survivors in Japanese community-based rehabilitation.

OBJECTIVE: The purposes of this study were as follows: (1) to compare the characteristics of functional fitness of Japanese stroke survivors with those of control subjects of a similar age; and (2) to relate these characteristics to the extent of physical impairment and the period after stroke onset to better design community-based rehabilitation programs for stroke survivors. DESIGN: One hundred fifty-three stroke survivors who participated in community-based rehabilitation and 119 control subjects were measured. Twelve performance test items were designed to assess functional fitness. RESULTS: The average functional fitness score for the stroke survivors was significantly lower than that of the control group. However, some survivors had higher performance scores than the control group. Significant correlations were shown between some functional fitness items and Brunnstrom recovery stage in the stroke survivors. CONCLUSION: The large variability in functional fitness scores for stroke survivors indicates a need to design variable rehabilitation programs so that survivors can be grouped according to their specific levels of functional fitness.

Selection and acquisition of audiovisual materials by health professionals.

Audiovisual (AV) materials are widely used in the education of health professionals, and health science educators are usually the people who select audiovisual teaching materials. However, little is known about the selection process and there are few parameters that can be used for guidance. No previous research was uncovered that documented the selection/acquisition of materials by users. This paper reports a survey of health science educators and resource consultants at forty-five academic health centers in the United States, on their experiences in identifying, selecting, and using AV materials. The results provide a baseline of information on which future research can build.

An epidemiological analysis of overuse injuries among recreational cyclists.

Two-hundred and ninety-four male and 224 female randomly selected recreational cyclists responded to a mail questionnaire. Significant differences were observed between male and female cyclists' training characteristics. Overall, 85% of the cyclists reported one or more overuse injury, with 36% requiring medical treatment. The most common anatomical sites for overuse injury/complaints reported by the male and female cyclists combined were the neck (48.8%), followed by the knees (41.7%), groin/buttocks (36.1%), hands (31.1%), and back (30.3%). For the male cyclists, effect upon back and groin/buttocks overuse injuries/complaints were miles/week, lower number of gears, and less years of cycling. For female cyclists, training characteristics which had the most significant effect upon groin/buttocks overuse injury/complaints were more non-competitive events/year and less stretching before cycling. The odds of female cyclists developing neck and shoulder overuse injury/complaints were 1.5 and 2.0 times more, respectively than their male counterparts.