Does ergometric stress test induce a procoagulative condition in patients with previous myocardial infarction

A regularly scheduled physical training program seems to have antithrombotic effects. Moreover, the hemostatic changes occurring in patients with coronary artery disease during acute exercise have not been clearly elucidated. Since stress testing is routinely performed in clinical cardiology, it would be helpful to assess whether patients with coronary artery disease are exposed to acute coronary thrombosis during or soon after sustained physical exercise. This study was designed to evaluate the effect of acute physical exercise (stress test by bicycle ergometer) on blood coagulation in a group of patients with previous myocardial infarction, and to determine whether the antithrombotic therapy commonly administered favorably influences hemostatic equilibrium. Our results suggest that exercise testing is not harmful to patients with previous myocardial infarction in regard to hemostasis and fibrinolysis and that antithrombotic therapy reduces postexercise increase in platelets

CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

<p>Abstract</p> <p>Background</p> <p>Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures.</p> <p>Methods/design</p> <p>Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model.</p> <p>Discussion</p> <p>By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00636675">NCT00636675</a></p

What Can We Learn about Smoking from 150 Years of Italian Data?

This paper estimates dynamic demand models for tobacco consumption in Italy from 1871 to 2010. The empirical analysis is based on an entirely new dataset. Because the tobacco sector was mostly managed by the state, rich and detailed historical documentation is available. Price elasticities are estimated both for aggregate tobacco consumption and its four major components (cigars, cigarettes, cut to- 25 bacco, and snuff) for three separate sub-periods: 1871–1913, 1919–1939, and 1946–2010. Elasticities consistently belong to a narrow set. We discuss the public policy implications of a seemingly iso-elastic tobacco demand function

I want to be someone, I want to make a difference: Young care leavers preparing for the future in South Australia

Improved education enhances life chances. Yet very few of those who have been in the care of the State proceed to higher education (HE). In Australia, care leavers are a subset of three demographics noted by the Bradley Review (2008) as continuing to be under-represented in HE: those from low socio-economic status (SES), rural, and Indigenous students. However, little is known specifically about care leavers in HE. In this chapter, we report on a small pilot project conducted recently in South Australia. For the project, we consulted with ten young care leavers, who told us about their experience with education and the encouragement they received, if any, to proceed onto HE. What we found was that most young people were neither expected nor encouraged to achieve academically.Dee Michell and Claudine Scalz

Nonlinear control techniques for the heart rate regulation in treadmill exercises

It has been recently shown in the literature that a robust output feedback controller for the heart rate regulation can be designed for an experimentally validated second order nonlinear model of the human heart rate response during long-duration treadmill exercises: It is based on piecewise linear approximations of the original nonlinear model and involves (local) robust linear control techniques. In this letter, we resort to recent nonlinear advanced control techniques in order to illustrate the existence of a nonlocal and nonswitching control which guarantees heart rate regulation with no exact knowledge of model parameters and nonlinearities: It simply generalizes to the nonlinear framework the classical proportional-integral control design for linear models of heart rate response during treadmill exercises. Simulation and experimental results demonstrate the effectiveness of the proposed approach in typical training exercises involving warm up/holding/cool down phases