Creatine supplementation during pregnancy: summary of experimental studies suggestion a treatment to improve fetal and neonatal morbidity and reduce mortality in high-risk human pregnancy

While the use of creatine in human pregnancy is yet to be fully evaluated, its long-term use in healthy adults appears to be safe, and its well documented neuroprotective properties have recently been extended by demonstrations that creatine improves cognitive function in normal and elderly people, and motor skills in sleep-deprived subjects. Creatine has many actions likely to benefit the fetus and newborn, because pregnancy is a state of heightened metabolic activity, and the placenta is a key source of free radicals of oxygen and nitrogen. The multiple benefits of supplementary creatine arise from the fact that the creatine-phosphocreatine [PCr] system has physiologically important roles that include maintenance of intracellular ATP and acid–base balance, post-ischaemic recovery of protein synthesis, cerebral vasodilation, antioxidant actions, and stabilisation of lipid membranes. In the brain, creatine not only reduces lipid peroxidation and improves cerebral perfusion, its interaction with the benzodiazepine site of the GABAA receptor is likely to counteract the effects of glutamate excitotoxicity – actions that may protect the preterm and term fetal brain from the effects of birth hypoxia. In this review we discuss the development of creatine synthesis during fetal life, the transfer of creatine from mother to fetus, and propose that creatine supplementation during pregnancy may have benefits for the fetus and neonate whenever oxidative stress or feto-placental hypoxia arise, as in cases of fetal growth restriction, premature birth, or when parturition is delayed or complicated by oxygen deprivation of the newborn

Prescribed fluid consumption and its effects on the physiology and work behaviour of Australian wildland firefighters

The present study examined firefighters\u27 ability to consume a prescribed fluid volume (1200 ml &middot; h-1) during a wildland fire suppression shift and compare the effect of this additional fluid prescription with self-paced drinking on firefighters\u27 hydration status and plasma sodium concentration post shift and their heart rate, core temperature and physical activity during their shift. Thirty-four firefighters were evenly divided into two drinking groups: self paced and prescribed. Prescribed drinkers did not meet the required 1200 ml&middot;h-1 intake, yet they consumed twice the fluid drank by the self-paced group. No differences were noted between groups in plasma sodium levels or hydration status before or after their shift. Prescribed fluid consumption resulted in significantly lower core temperature between two and six hours into the shift. This did not coincide with lower cardiovascular strain, greater physical activity when compared to the self-paced drinking group. Additional fluid consumption (above self-paced intake) did not improve firefighter activity or physiological function (though it may buffer rising core temperature). It seems that wildland firefighters, at least in mild to warm weather conditions, can self-regulate their fluid consumption and work behaviour to leave the fireground hydrated at the conclusion of their shift.<br /

Narrative change in psychotherapy: differences between good and bad outcome cases in cognitive, narrative, and prescriptive therapies

This study aimed to clarify the relationship between changes in the patients’ narratives and therapeutic outcomes. Two patients were selected from three psychotherapeutic models (cognitive, narrative, and prescriptive therapies), one with good therapeutic outcome and the other with bad therapeutic outcome. Sessions from the initial, middle, and final phases for each patient were evaluated in terms of narrative structural coherence, process complexity, and content diversity. Differences between patients’ total narrative production were found at the end of the therapeutic process. Good outcome cases presented a higher statistically significant total narrative change than poor outcome case

Improving eye care for veterans with diabetes: An example of using the QUERI steps to move from evidence to implementation: QUERI Series

<p>Abstract</p> <p>Background</p> <p>Despite being a critical part of improving healthcare quality, little is known about how best to move important research findings into clinical practice. To address this issue, the Department of Veterans Affairs (VA) developed the Quality Enhancement Research Initiative (QUERI), which provides a framework, a supportive structure, and resources to promote the more rapid implementation of evidence into practice.</p> <p>Methods</p> <p>This paper uses a practical example to demonstrate the use of the six-step QUERI process, which was developed as part of QUERI and provides a systematic approach for moving along the research to practice pipeline. Specifically, we describe a series of projects using the six-step framework to illustrate how this process guided work by the Diabetes Mellitus QUERI (DM-QUERI) Center to assess and improve eye care for veterans with diabetes.</p> <p>Results</p> <p>Within a relatively short time, DM-QUERI identified a high-priority issue, developed evidence to support a change in the diabetes eye screening performance measure, and identified a gap in quality of care. A prototype scheduling system to address gaps in screening and follow-up also was tested as part of an implementation project. We did not succeed in developing a fully functional pro-active scheduling system. This work did, however, provide important information to help us further understand patients' risk status, gaps in follow-up at participating eye clinics, specific considerations for additional implementation work in the area of proactive scheduling, and contributed to a change in the prevailing diabetes eye care performance measure.</p> <p>Conclusion</p> <p>Work by DM-QUERI to promote changes in the delivery of eye care services for veterans with diabetes demonstrates the value of the QUERI process in facilitating the more rapid implementation of evidence into practice. However, our experience with using the QUERI process also highlights certain challenges, including those related to the hybrid nature of the research-operations partnership as a mechanism for promoting rapid, system-wide implementation of important research findings. In addition, this paper suggests a number of important considerations for future implementation work, both in the area of pro-active scheduling interventions, as well as for implementation science in general.</p

The effect of endurance training on human ammonia metabolism

This thesis examines human ammonia (NH3) metabolism in trained and untrained individuals. Specifically, these aspects include: 1) plasma NH3 accumulation during exercise at similar absolute and relative work intensities; 2) plasma NH3 accumulation during recovery from maximal exercise; 3) the absolute and relative work intensities at which blood lactate (LA) and plasma NH3 concentrations begin to rapidly accumulate (i.e the LA breakpoint - LABP, and NH3 breakpoint - NH3BP); 4) the relationship between the NH3BP and LABP, and 5) the relationship between plasma NH3, blood (LA), and muscle fibre type

Amino acids and endurance exercise

Provides information on a study which examined the role of amino acids during endurance exercise and the implications for sports nutrition and performance. Description of amino acid utilization during exercise; Function of glutamine; Cardiovascular function of L-arginine.<br /