Living high–training low: effect on erythropoiesis and maximal aerobic performance in elite Nordic skiers

The “living high–training low” model (Hi–Lo) may improve aerobic performance in athletes, and the main mechanism of this improvement is thought to be augmented erythropoiesis. A positive effect of Hi–Lo has been demonstrated previously by using altitudes of 2,000–3,000 m. Since the rate of erythropoiesis is altitude-dependent, we tested whether a higher altitude (3,500 m) during Hi–Lo increases erythropoiesis and maximal aerobic performance. Nordic skiers trained for 18 days at 1,200 m, while sleeping at 1,200 m in ambient air (control group, n = 5) or in hypoxic rooms (Hi–Lo, n = 6; 3 × 6 days at simulated altitudes of 2,500, 3,000 and finally 3,500 m, 11 h day⁻¹). Measurements were done before, during (blood samples only) and 2 weeks after the intervention (POST). Maximal aerobic performance was examined from and time to exhaustion (T _exh) at (minimum speed associated with ), respectively. Erythropoietin and soluble transferrin receptor responses were higher during Hi–Lo, whereas reticulocytes did not change. In POST (vs. before): hematological parameters were similar to basal levels, as well as red blood cell volume, being 2.68 ± 0.83 l (vs. 2.64±0.54 l) in Hi–Lo and 2.62±0.57 l (vs. 2.87 ± 0.59 l) in controls. At that time, neither nor T _exh were improved by Hi–Lo, being non-significantly decreased by 2.0% (controls) and 3.7% (Hi–Lo). The present results suggest that increasing the altitude up to 3,500 m during Hi–Lo stimulates erythropoiesis but does not confer any advantage for maximal O₂ transport.     

How do infants adapt to loading of the limb during the swing phase of stepping?

Previous results from this laboratory have shown that human infants (<12 mo old) respond appropriately to transient changes in sensory input during stepping. We examined how infants adapted to a more enduring change in sensory input by applying load to one limb during stepping. A small weight (500-900 g) was strapped around the lower leg of infants aged 3-11 mo. Stepping with the weight on was recorded on the treadmill for a period of 0.5-3 min. The weight was then quickly detached during stepping, and the immediate response to unexpected loss of the weight recorded. Three-segment dynamic analysis of leg motion was used to estimate hip, knee, and ankle torques during swing in the sagittal plane. All infants adapted to the additional load on the leg by immediately increasing the generation of hip and knee flexor muscle torques. When the weight was removed, 7 of the 22 infants tested exhibited an after-effect (high stepping) in the first step after removal of the weight. The after-effect was manifested as an increase in toe trajectory height and hip flexion and coincided with higher hip flexor muscle torque in early swing. In an additional series of control experiments using seven infants, after-effects were shown to be unrelated to a sudden change in cutaneous input with removal of the weight. The presence of an after-effect indicates that some infants made an enduring adaptation to their stepping pattern that is revealed with the unexpected removal of the weight.     

How does skin adapt to repetitive mechanical stress to become load tolerant?

Skin breakdown from mechanical stress application is a difficult health care problem for lower-limb amputees using prosthetic limbs. Post-operative treatments to encourage skin adaptation do exist, but are largely unsuccessful. Potentially, by understanding skin adaptation on a molecular level, appropriate biomolecules can be identified and then delivered to skin to encourage adaptation in at-risk patients. Based from a critical review of the literature, it is expected that adaptation occurs by forming new collagen fibrils with larger diameters as opposed to increasing diameters of existing fibrils. Small collagen fibril breakdown by stress activated metalloproteinases is expected to be followed by increased expressions of decorin, biglycan, fibromodulin, lumican, thrombospondin-2, and collagens I and III, facilitating formation of new fibrils with larger diameters. After remodeling, total collagen fibril cross-sectional area is expected to return to baseline values since increased collagen content would increase mass and be redundant towards the purpose of adaptation.     

How well do women adapt to changes in their body size and shape across the course of pregnancy?

This study examined body image across pregnancy. Pregnant women ( N = 158) completed measures of general attractiveness, feeling fat, fitness and strength, salience of weight and shape, and ideal and current body size at pre-pregnancy (retrospective), and in early, middle and late pregnancy. Body image was found to be fairly stable across pregnancy such that women who started with greater body concerns maintained them over time. Although women were least satisfied with their stomach size at late pregnancy, women's ideal body shape increased in parallel with increases in body size. Women with the most body concerns reported more depressive symptoms, tendency towards dieting, and smoking during pregnancy suggesting they were at greater risk in terms of health and well-being during pregnancy.     

How to produce a pulsatile flow with low haemolysis?

It is evident that a pulsatile flow is important for blood circulation because the flow pulsatility can reduce the resistance of peripheral vessels. It is difficult, however, to produce a pulsatile flow with an impeller pump, since blood damage will occur when a pulsatile flow is produced. Further investigation has revealed that the main factor for blood damage is turbulence shear, which tears the membranes of red blood cells, resulting in free release of haemoglobin into the plasma, and consequently leads to haemolysis. Therefore, the question for developing a pulsatile impeller blood pump is: how to produce a pulsatile flow with low haemolysis? The authors have successively developed a pulsatile axial pump and a pulsatile centrifugal pump. In the pulsatile axial pump, the impeller reciprocates axially and rotates simultaneously. The reciprocation is driven by a pneumatic device and the rotation by a dc motor. For a pressure of 40 mm Hg pulsatility, about 50 mm axial reciprocating amplitude of the impeller is desirable. In order to reduce the axial amplitude, the pump inlet and the impeller both have cone-shaped heads, and the gap between the impeller and the inlet pipe changes by only 2 mm, that is the impeller reciprocates up to 2 mm and a pressure pulsatility of 40 mm Hg can be produced. As the impeller rotates with a constant speed, low turbulence in the pump may be expected. In the centrifugal pulsatile pump, the impeller changes its rotating speed periodically; the turbulence is reduced by designing an impeller with twisted vanes which enable the blood flow to change its direction rather than its magnitude during the periodic change of the rotating speed. In this way, a pulsatile flow is produced and the turbulence is minimized. Compared to the axial pulsatile pump, the centrifugal pulsatile pump needs only one driver and thus has more application possibilities. The centrifugal pulsatile pump has been used in animal experiments. The pump assisted the circulation of calves for several months without harm to the blood elements and the organ functions of the experimental animal. The experiments demonstrated that the pulsatile impeller pump is the most efficient pump for assisting heart recovery, because it can produce a pulsatile flow like a diaphragm pump and has no back flow as occurs in a non-pulsatile rotary pump; the former reduces the circulatory resistance and the latter increases the diastole pressure in aorta and thus increases the perfusion of coronary arteries of the natural heart.     

Introduction: How can research discover how to do psychotherapy?

It is almost exceptional that psychotherapy researchers set out to answer questions like these: What are some new and better ways of doing actual in-session psychotherapeutic work? What are some new and better changes that psychotherapy can help bring about, and what are some new and better ways of helping to bring them about? The purpose of this special series of papers is to provide a forum for researchers to tell how to do research to answer those questions, i.e., to present practical and useful methodologies, designs, and strategies that are helpful in answering these questions.     

How well do school-aged children comply with imposed sleep schedules at home?

STUDY OBJECTIVES: To quantitatively assess compliance and experimental success with imposed sleep schedules among healthy children involved in an experimental comparison of optimized and restricted sleep. DESIGN: We asked children to follow assigned sleep schedules at home that created optimized (at least 10 hours time-in-bed per night) and restricted (6.5 to 8 hours time-in-bed per night) sleep conditions across 2 weeks during the school year. Self-report or parent-report of bedtime and risetime was obtained daily and continuous actigraphy was recorded. SETTING: Home. PARTICIPANTS: 78 healthy children (41 boys, 37 girls; mean age, 10.2 years; age range, 6.5 to 12.9 years) INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We used reported time-in-bed to assess noncompliance with assigned schedules. Experimental failure was assessed with actigraphically based estimates of sleep period (time from sleep onset to sleep offset) and total sleep time (minutes of scored sleep during sleep period). Reported time-in-bed averaged 3.45 hours less per night under restricted versus optimized conditions. Sleep period and total sleep time showed similar differences (2.97 and 2.32 hours less, respectively). Four children met a priori criteria for noncompliance (3 for optimized nights and 1 for restricted). Eight children met a priori criteria for experimental failure within conditions (7 for optimized nights and 1 for restricted), but most achieved a substantial difference in sleep behavior across optimized and restricted weeks. CONCLUSIONS: In general, healthy children as young as 6 years of age can maintain substantial changes in their usual schedules across several nights at home and should be considered for inclusion in experimental studies of sleep extension and restriction. This paper offers a methodologic "road-map" for scientists interested in pursuing this goal.     

How often do patients with psychosis fail to adhere to treatment programmes? A systematic review

BACKGROUND: Studies that assess the rates of psychotic patients who fail to adhere to treatment programmes have generated heterogeneous results, with estimates ranging from 24 to 90%. This paper presents findings from a systematic review on adherence to treatment by patients with psychosis. Its purpose is to provide an overall estimate of treatment non-adherence in community psychiatric services, and to analyse and study patient characteristics explaining the between-study heterogeneity in rates of non-adherence. METHOD: A systematic review of published studies that report rates of non-adherence with medication and scheduled appointments by psychotic patients in community settings has been undertaken. RESULTS: A total of 103 studies were included in this systematic review. Eighty-six of these studies were suitable for data re-analysis. The overall weighted mean rate of non-adherence, calculated in a sample of 23 796 patients, was 25.78%. A linear regression analysis of non-adherence rates on background characteristics showed that sample size was negatively associated with non-adherence rates, while first-contact cases and low-adherence cases, in comparison with ongoing cases, were associated with higher non-adherence rates. Factors associated with poor compliance included: lack of insight; positive symptoms; younger age; male gender; history of substance abuse; unemployment; and low social functioning. CONCLUSIONS: Approximately one in four patients with psychosis fails to adhere with treatment programmes. Preventive evidence-based clinical interventions should be routinely implemented in community settings to reduce patient non-adherence.     

How high are carrier frequencies of rare recessive syndromes? Contemporary estimates for Fanconi Anemia in the United States and Israel

For many recessive genetic syndromes, carrier frequencies have been assessed through screening studies in founder populations but remain unclear in heterogeneous populations. One such syndrome is Fanconi Anemia (FA). FA is a model disease in cancer research, yet there are no contemporary data on carrier frequency or prevalence in the general United States (US) population or elsewhere. We inferred carrier frequency from birth incidence using the Hardy-Weinberg law. We estimated prevalence using birth incidence and survival data. We defined "plausible ranges" to incorporate uncertainty about completeness of case ascertainment. We made estimates for the US and Israel using demographic data from the Fanconi Anemia Research Fund and Israeli Fanconi Anemia Registry. In the US, a plausible range for the carrier frequency is 1:156-1:209 [midpoint 1:181]; we estimate that 550-975 persons were living with FA in 2010. For Israel, a plausible range for the carrier frequency is 1:66-1:128 [midpoint 1:93] in line with founder screening studies; we estimate that 40-135 Israelis were living with FA in 2008. The estimated US FA carrier frequency of 1:181 is significantly higher than the historical estimate of 1:300; hence, the gap may be narrower than previously recognized between the US carrier frequency and higher carrier frequencies of around 1:100 in several founder groups including Ashkenazi Jews. Assessment of cancer risks in heterozygous carriers merits further study. Clinical trials in FA will require co-ordination and innovative design because the number of living US patients is probably less than 1,000.     

How do social firms contribute to recovery from mental illness? A qualitative study

Background: A definition of recovery drawn from qualitative literature and the ‘consumer/survivor’ movement suggests that recovery should be seen as a way of developing satisfaction and purpose in life, whether or not symptoms of mental illness are present. A qualitative review suggested that meaningful activity may facilitate recovery by providing a sense of purpose in life. Social firms may be well placed to offer this activity due to their ethos of empowerment, their community integration and their similarity to ‘recovery‐oriented services’. Aims: The aim of this study was to explore experiences of recovery from mental illness in the context of two emerging social firms. Method: A social constructionist version of grounded theory was used to develop a model of recovery through participation in the emerging social firms. Multiple coding, triangulation and respondent validation were used to increase the rigour of study findings. Findings: A model of recovery in the context of the emerging social firms was constructed. This was influenced by characteristics such as a flexible structure, a meaningful and diverse activity, an accepting social group and an inclusive leadership. Conclusion: Social firms may provide an important model for ‘recovery‐oriented services’. Clinical, research and policy implications of findings are discussed. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message:

• Social firms are a form of enterprise that employs people who are disadvantaged in the labour market by their disability.
• Social firms promote a model of community integration and empowerment for their employees.
• We found that individuals recovering from a mental illness experience social firms as providing a flexible environment which promotes feelings of belonging, success, competence and individuality.
• We interpret these findings as social firms providing secure base for recovery.