Short-Term Removal of Exercise Impairs Glycemic Control in Older Adults: A Randomized Trial

Postprandial glycemia (PPG) predicts cardiovascular disease, and short-term physical inactivity increases PPG in young, active adults. Whether this occurs in older, active adults who may be more prone to bouts of inactivity is unknown. This study determined if postprandial interstitial glucose (PPIG) was impaired in active older adults following the removal of exercise for 3 days (NOEX) compared to active young adults. In this randomized, crossover study, 11 older (69.1 ± 1.9 years) and 9 young (32.8 ± 1.8 years) habitually active (≥90 min/week of exercise) adults completed 3-days of NOEX and 3-days of normal habitual exercise (EX), separated by ≥1 week. Diet was standardized across phases. Glycemic control (3-day average) was assessed via continuous glucose monitoring during both phases. Significant main effects of age and phase were detected (p \u3c 0.05), but no interaction was found for steps/day (p \u3e 0.05) (old EX: 6283 ± 607, old NOEX: 2380 ± 382 and young EX: 8798 ± 623, young NOEX: 4075 ± 516 steps/day). Significant main effects of age (p = 0.002) and time (p \u3c 0.001) existed for 1-h PPIG, but no effect of phase or interactions was found (p \u3e 0.05). Significant main effects (p \u3c 0.05) of age (old: 114 ± 1 mg/dl, young: 106 ± 1 mg/dl), phase (NOEX: 112 ± 1 mg/dl, EX: 108 ± 1 mg/dl), and time (0 min: 100 ± 2, 30 min: 118 ± 2, 60 min: 116 ± 2, 90 min: 111 ± 2, 120 min: 108 ± 2 mg/dl) in 2-h PPIG were detected, but no interaction was found (p \u3e 0.05). However, only significant main effects of phase (NOEX: 14 ± 1 and EX:12 ± 1, p \u3e 0.05) were found for 24-h blood glucose standard deviation. Older adults appear to have impaired glycemic control compared to young adults and exercise removal impairs glycemic control in both populations. Yet, the impairment in glycemic control with exercise removal is not different between old and young adults

“What if There's Something Wrong with Her?”‐How Biomedical Technologies Contribute to Epistemic Injustice in Healthcare

While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader implications for just and equitable healthcare delivery

Organizational and Environmental Context for Including Advanced Practice Providers in UPMC Hospitalist Models

This study qualitatively examines the environmental and organizational context driving the implementation of advanced practice providers (APPs) in hospital medicine at UPMC. We utilized a comparison case study methodology, including field observation and semi-structured interviews at two hospital medicine programs. We identified three distinct models of APPs in hospital medicine, including the Team Approach, Divide and Conquer, and a Hybrid model, and linked the evolution of these models to contextual factors. Our findings present unique insight into the roles of APPs on UPMC hospital medicine teams. We show that environmental pressures, organizational initiatives, and clinician experience can influence APP roles

INSIGHTS ON THE EFFICACY OF VISION EXAMINATIONS & VISION SCREENINGS FOR CHILDREN FIRST ENTERING SCHOOL

Abstract In the year 2000, a law was passed in Kentuck

Vision 2020: A View of Our Energy Future

The Morning Address was given by The Honorable George Allen. “The Regulatory Framework: Where Are We Headed?” session by Eric Finkbeiner, Senior Adviser for Policy, Office of Governor Robert McDonnell; David Christian, Chief Executive Officer, Dominion Generation; and Professor Joel Eisen, University of Richmond School of Law. Professor Noah Sachs, University of Richmond School of Law, served as moderator. “The Future of Coal” session by John Lain, Partner at McGuireWoods LLP; Cale Jaffe, Senior Attorney with the Southern Environmental Law Center; and W. Thomas Hudson, President of W. Thomas Hudson and Associates, Inc. and of the Virginia Coal Association. Stephen E. Taylor, Allen Chair Editor for the University of Richmond Law Review, served as moderator. “Nuclear Power: Is There a ‘Renaissance’?” session by Donald Irwin, Hunton & Williams; Christopher Paine, Director of Nuclear Program, Natural Resources Defense Council (invited); and Michael H. Montgomery, Vice President of Fuel Development, Lightbridge Corporation. Tricia Dunlap, Robert R. Merhige, Jr. Fellow at the University of Richmond School of Law, served as moderator. “Emerging Issues in Energy Policy” session by Mark Rosen, Deputy General Counsel, CNA Corporation; Jefferson Reynolds, Water Policy Director with the Virginia Department of Environmental Quality; Kruskaia Sierra-Escalante, Senior Counsel for the International Finance Corporation; and Edward Lowe, General Manager for Renewable Energy Market Development, GE Energy. Andrea W. Wortzel, Counsel with Hunton & Williams and Vice Chair of the Environmental Law Section of the Virginia State Bar, served as moderator. The Closing Address was given by The Honorable Carol M. Browner, Assistant to the President for Energy and Climate Change and Former Administrator of the Environmental Protection Agency (invited)

A Silent Enzootic of an Orthopoxvirus in Ghana, West Africa: Evidence for Multi-Species Involvement in the Absence of Widespread Human Disease

Human monkeypox has never been reported in Ghana, but rodents captured in forested areas of southern Ghana were the source of the monkeypox virus introduced into the United States in 2003. Subsequent to the outbreak in the United States, 204 animals were collected from two commercial trapping sites in Ghana. Animal tissues were examined for the presence of orthopoxvirus (OPXV) DNA using a real-time polymerase chain reaction, and sera were assayed for antibodies against OPXV. Animals from five genera (Cricetomys, Graphiurus, Funiscirus, and Heliosciurus) had antibodies against OPXV, and three genera (Cricetomys, Graphiurus, and Xerus) had evidence of OPXV DNA in tissues. Additionally, 172 persons living near the trapping sites were interviewed regarding risk factors for OPXV exposure, and their sera were analyzed. Fifty-three percent had IgG against OPXV; none had IgM. Our findings suggest that several species of forest-dwelling rodents from Ghana are susceptible to naturally occurring OPXV infection, and that persons living near forests may have low-level or indirect exposure to OPXV-infected animals, possibly resulting in sub-clinical infections

Lack of SARS Transmission among Public Hospital Workers, Vietnam

The severe acute respiratory syndrome (SARS) outbreak in Vietnam was amplified by nosocomial spread within hospital A, but no transmission was reported in hospital B, the second of two designated SARS hospitals. Our study documents lack of SARS-associated coronavirus transmission to hospital B workers, despite variable infection control measures and the use of personal protective equipment

Pain Input After Spinal Cord Injury (SCI) Undermines Long-Term Recovery and Engages Signal Pathways That Promote Cell Death

Pain (nociceptive) input caudal to a spinal contusion injury increases tissue loss and impairs long-term recovery. It was hypothesized that noxious stimulation has this effect because it engages unmyelinated pain (C) fibers that produce a state of over-excitation in central pathways. The present article explored this issue by assessing the effect of capsaicin, which activates C-fibers that express the transient receptor potential vanilloid receptor-1 (TRPV1). Rats received a lower thoracic (T11) contusion injury and capsaicin was applied to one hind paw the next day. For comparison, other animals received noxious electrical stimulation at an intensity that engages C fibers. Both forms of stimulation elicited similar levels of c-fos mRNA expression, a cellular marker of nociceptive activation, and impaired long-term behavioral recovery. Cellular assays were then performed to compare the acute effect of shock and capsaicin treatment. Both forms of noxious stimulation increased expression of tumor necrosis factor (TNF) and caspase-3, which promotes apoptotic cell death. Shock, but not capsaicin, enhanced expression of signals related to pyroptotic cell death [caspase-1, inteleukin-1 beta (IL-1ß)]. Pyroptosis has been linked to the activation of the P2X7 receptor and the outward flow of adenosine triphosphate (ATP) through the pannexin-1 channel. Blocking the P2X7 receptor with Brilliant Blue G (BBG) reduced the expression of signals related to pyroptotic cell death in contused rats that had received shock. Blocking the pannexin-1 channel with probenecid paradoxically had the opposite effect. BBG enhanced long-term recovery and lowered reactivity to mechanical stimulation applied to the girdle region (an index of chronic pain), but did not block the adverse effect of nociceptive stimulation. The results suggest that C-fiber input after injury impairs long-term recovery and that this effect may arise because it induces apoptotic cell death

Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003

BACKGROUND: In March of 2003, an outbreak of Severe Acute Respiratory Syndrome (SARS) occurred in Northern Vietnam. This outbreak began when a traveler arriving from Hong Kong sought medical care at a small hospital (Hospital A) in Hanoi, initiating a serious and substantial transmission event within the hospital, and subsequent limited spread within the community. METHODS: We surveyed Hospital A personnel for exposure to the index patient and for symptoms of disease during the outbreak. Additionally, serum specimens were collected and assayed for antibody to SARS-associated coronavirus (SARS-CoV) antibody and job-specific attack rates were calculated. A nested case-control analysis was performed to assess risk factors for acquiring SARS-CoV infection. RESULTS: One hundred and fifty-three of 193 (79.3%) clinical and non-clinical staff consented to participate. Excluding job categories with <3 workers, the highest SARS attack rates occurred among nurses who worked in the outpatient and inpatient general wards (57.1, 47.4%, respectively). Nurses assigned to the operating room/intensive care unit, experienced the lowest attack rates (7.1%) among all clinical staff. Serologic evidence of SARS-CoV infection was detected in 4 individuals, including 2 non-clinical workers, who had not previously been identified as SARS cases; none reported having had fever or cough. Entering the index patient's room and having seen (viewed) the patient were the behaviors associated with highest risk for infection by univariate analysis (odds ratios 20.0, 14.0; 95% confidence intervals 4.1–97.1, 3.6–55.3, respectively). CONCLUSION: This study highlights job categories and activities associated with increased risk for SARS-CoV infection and demonstrates that a broad diversity of hospital workers may be vulnerable during an outbreak. These findings may help guide recommendations for the protection of vulnerable occupational groups and may have implications for other respiratory infections such as influenza