Quadriceps-hamstring EMG activity during functional, closed kinetic chain exercise to fatigue

It has been hypothesized that the ability of the neuromuscular system to co-contract muscles for joint stabilization may be impaired during the development of fatigue. The purpose of this study was to examine muscle activation of the quadriceps and hamstring muscles during a prolonged closed kinetic chain exercise, the forward lunge. Eight males and two females [mean (SD) age 26.0 (2.3) years, height 177.2 (13.6) cm, body mass 82.8 (17.1) kg] with no prior knee pathology volunteered for this study. Subjects performed repeated forward lunges onto their dominant leg at the cadence of one full lunge cycle every 2 s, until the point of volitional failure. Digital switches were positioned to record foot-strike and knee-strike of the lunge leg at the midpoint of the lunge, as well as heel-strike upon return to stance. During the lunge performance, surface electromyographic (EMG) signals of the vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), and semitendinosus (ST) muscles of the supporting leg were measured. Heart rate was also monitored every 30 s during the performance. All EMG data were full-wave rectified, partitioned into up and down phases, and integrated over the entire exercise period. The results demonstrated a significant increase in activation of the VL, VM, and BF during performance of the forward lunge to volitional failure (P < 0.05). No significant increase was shown for the ST. Heart rate increased significantly over the course of the lunge. These findings suggest that activation of the VL, VM, and BF muscles occurs as a unit during performance of the forward lunge during both concentric and eccentric lunge phases. Accepted: 25 October 1999     

Expert systems in the health administration curriculum

With the growing use of computers and on-line hospital information systems, a need exists for health care managers trained in computing and computer applications. This article reviews the advances in health care computing and reports on the design and implementation of a new course in a specific computer application, known as expert systems, in a health administration curriculum. The specific course framework is described and several student projects are presented and discussed.     

Mustard operation in the 1st month of life

Since April 1976, nine infants less than 1 month of age underwent a Mustard intraatrial baffle procedure. All had transposition of the great arteries and were persistently symptomatic or hypoxic after the Rashkind balloon atrioseptostomy. Two had an associated large ventricular septal defect patched at the time of physiologic correction. The average age of the infants was 11.6 days (range 36 hours to 28 days). Weight averaged 3.4 kg (range 2.5 to 4.2). In all the Mustard procedure was performed using deep hypothermie circulatory arrest, averaging 71 minutes (range 48 to 88) at a mean core temperature of 13 °C. An average of 2.8 days of postoperative ventilatory assistance was required. One death occurred in a 28 day old male infant with an associated ventricular septal defect who, the morning after operation, had a sudden unresponsive cardiac standstill. The postoperative hospitalization period averaged 15 days (range 10 to 23). Follow-up evaluation has extended from 4 to 63 months (average 31). Six patients were restudied 2 to 21 months postoperatively. One had obstruction of the superior limb of the baffle, which had separated from the right atrial wall permitting a modest right to left shunt. She has had uneventful repair employing a unique modification of Senning's operation. Another child has asymptomatic partial obstruction of the superior limb of the baffle demonstrated angiographically. None has pulmonary venous obstruction and all have prevailing normal sinus rhythm. Significant right ventricular dysfunction has been demonstrated in one. Early correction in these persistently symptomatic or hypoxic neonates with transposition of the great arteries with or without a ventricular septal defect has obviated the need for palliative operations and produced gratifying early and late results.     

Financial Reinforcers for Improving Medication Adherence: Findings from a Meta-analysis

BackgroundIncreasingly, financial reinforcement interventions based on behavioral economic principles are being applied in health care settings, and this study examined the use of financial reinforcers for enhancing adherence to medications.MethodsElectronic databases and bibliographies of relevant references were searched, and a meta-analysis of identified trials was conducted. The variability in effect size and the impact of potential moderators (study design, duration of intervention, magnitude of reinforcement, and frequency of reinforcement) on effect size were examined.ResultsFifteen randomized studies and 6 nonrandomized studies examined the efficacy of financial reinforcement interventions for medication adherence. Financial reinforcers were applied for adherence to medications for tuberculosis, substance abuse, human immunodeficiency virus, hepatitis, schizophrenia, and stroke prevention. Reinforcement interventions significantly improved adherence relative to control conditions with an overall effect size of 0.77 (95% confidence interval, 0.70-0.84; P < .001). Nonrandomized studies had a larger average effect size than randomized studies, but the effect size of randomized studies remained significant at 0.44 (95% confidence interval, 0.35-0.53; P < .001). Interventions that were longer in duration, provided an average reinforcement of $50 or more per week, and reinforced patients at least weekly resulted in larger effect sizes than those that were shorter, provided lower reinforcers, and reinforced patients less frequently.ConclusionThese results demonstrate the efficacy of medication adherence interventions and underscore principles that should be considered in designing future adherence interventions. Financial reinforcement interventions hold potential for improving medication adherence and may lead to benefits for both patients and society.     

Advanced Pharmacy Practice Experiences in Pharmacogenomics Offered by US Pharmacy Programs

Objective. To characterize advanced pharmacy practice experiences (APPEs) with a primary focus in pharmacogenomics at schools and colleges of pharmacy in the United States.Methods. This was a cross-sectional, multicenter, observational study of pharmacogenomics APPEs at US pharmacy schools. Directors of experiential education at 146 accredited schools of pharmacy were contacted by phone and asked if their school offered a pharmacogenomics APPE. The preceptors of pharmacogenomics APPEs identified by this phone screen were sent an email with a link to an online survey that asked about their APPE offerings.Results. Of the 142 schools of pharmacy that were successfully reached via phone, 40 (28%) offered an APPE with a primary focus in pharmacogenomics. Thirty unique APPEs with pharmacogenomics as a primary focus were identified. The total number of preceptors involved in the pharmacogenomics APPEs was 33: 19 (58%) faculty preceptors and 14 (42%) non-faculty preceptors. Twenty-three of the 30 pharmacogenomics APPEs completed the survey (77% response rate). The APPE sites were diverse and included academic medical centers, community health systems, pharmacogenomic testing laboratories, and schools of pharmacy. Each pharmacogenomics APPE accommodated an average of six students per year. The APPE activities varied across sites.Conclusion. Only a small number of US pharmacy schools offer an APPE with a primary focus in pharmacogenomics. These rotations are diverse in scope and precepted by faculty or non-faculty pharmacists. The Academy should pursue opportunities to increase experiential education in pharmacogenomics.     

Substance abuse treatment patients with early onset cocaine use respond as well to contingency management interventions as those with later onset cocaine use

Early onset drug use is associated with increased risk of developing substance use disorders, but relatively little is known about the correlates of early drug use among adults receiving treatment. A retrospective analysis of a randomized study of contingency management treatment compared cocaine-dependent patients who reported initial cocaine use at age 14 or younger (n = 41) to those who began using after age 14 (n = 387). Patients with early onset cocaine use had more legal and psychiatric problems than those who initiated cocaine use later. Patients with early-onset cocaine use also dropped out of treatment sooner and achieved less sustained abstinence than those who began using at older ages, but the interaction between age of first use and treatment condition was not significant. Early-onset cocaine use is associated with persistent psychosocial problems and an overall poor response to treatment. However, contingency management is efficacious in improving outcomes in early onset cocaine users.     

A comparison of treatment-seeking pathological gamblers based on preferred gambling activity

Aims To compare and contrast gamblers with different forms of problematic gambling activities. Design, setting and measurements Pathological gamblers completed the Addiction Severity Index (ASI) and gambling questionnaires when initiating out‐patient treatment. Participants Participants (n = 347) were categorized by their most problematic form of gambling activity: sports, horse/dog‐races, cards, slots and scratch/lottery tickets. Differences in demographics, gambling variables, and ASI composite scores were compared across groups. Findings After controlling for demographic variables, the types of gamblers differed in severity of gambling, alcohol and psychiatric problems. Horse/dog‐race gamblers were generally older, male and less educated; they began gambling regularly at a young age and spent relatively high amounts of money gambling. Sports gamblers were young males and had intermediary gambling problems; they had relatively high rates of current substance use but few psychiatric problems. Card players spent low to moderate amounts of time and money gambling, and they generally reported few alcohol problems and little psychiatric distress. Slot machine players were older and more likely to be female. Slot gamblers began gambling later in life, had high rates of bankruptcy and reported psychiatric difficulties. Scratch/lottery gamblers spent the least amount of money gambling, but they gambled the most frequently and had relatively severe alcohol and psychiatric symptoms. Conclusions Gambling patterns and severity of psychosocial problems vary by form of problematic gambling, and these differences may influence treatment recommendations and outcomes.