Methods and protocols for incremental exercise testing in tetraplegia, using arm-crank ergometry assisted by Functional Electrical Stimulation

Cervical spinal cord injury (SCI) leads to tetraplegia, with paralysis and loss of sensation in the upper and lower limbs. The associated sedentary lifestyle results in an increased risk of cardiovascular disease. To address this, we require the design of exercise modalities aimed specifically at tetraplegia and methods to assess their efficacy. This paper describes methods for arm-crank ergometry (ACE) assisted by Functional Electrical Stimulation (FES) applied to the biceps and triceps. The instrumented ergometer enables work-rate control during exercise, implemented here for incremental exercise testing during FES-ACE. Detailed protocols for the tests are given. Experimental data collected during exercise tests with tetraplegic volunteers are provided to illustrate the feasibility of the proposed approach to testing and data analysis. Incremental tests enabled calculation of peak power output and peak oxygen uptake. We propose that the high-precision exercise testing protocols described here are appropriate to assess the efficacy of the novel exercise modality, FES-ACE, in tetraplegia

How can multimedia be designed to assist comprehension of the literary text for foreign language learners?

Educational software for foreign language reading often focuses solely on reading as a process of decoding and ignores the importance of hypothesis testing a reader does to comprehend a text. The purpose of this research study was to devise a computer-integrated multimedia program informed by research in second language reading that might assist students\u27 comprehension of the short literary text in Spanish Es que somos muy pobres by Mexican author, Juan Rulfo. The design of this multimedia product targeted both top-down and bottom-up processing in reading, i.e. hypothesis-testing and decoding and therefore included: (1) pre-reading strategies shown to increase comprehension for foreign language students, as well as (2) supplemental material to augment their socio-cultural background knowledge and (3) an interactive glossary to provide them with definitions of unknown vocabulary. These multimedia materials were pressed into CD-ROMs for an experimental study carried out with students in the intermediate Spanish course at the University of Pennsylvania., to see if the multimedia program had a positive effect on learning. Four assessments of learning gains were carried out with a control group and an experimental multimedia group. These measurements were: (1) comprehension quiz; (2) an immediate vocabulary recall measurement; (3) a test of recall of the narrative two weeks following the reading; and (4) a delayed vocabulary recall measurement two weeks after the study. Students also answered a questionnaire reporting on the aspects they liked or disliked in the multimedia program and what aspects of the technology appeared to aid or hinder their reading. The study found that this particular multimedia program was successful in assisting students\u27 reading comprehension of the foreign language text. The multimedia group scored particularly higher than the control group in questions requiring the use of inference, analysis and synthesis in reading. With regards to the students\u27 acquisition of new vocabulary words, the students who used the interactive glossary showed a statistically significant improvement over the control group but the number of vocabulary words acquired was quite small. Both delayed assessments, the recall of the narrative and the recall of vocabulary did not show significant differences between groups

How can multimedia be designed to assist comprehension of the literary text for foreign language learners?

Educational software for foreign language reading often focuses solely on reading as a process of decoding and ignores the importance of hypothesis testing a reader does to comprehend a text. The purpose of this research study was to devise a computer-integrated multimedia program informed by research in second language reading that might assist students\u27 comprehension of the short literary text in Spanish Es que somos muy pobres by Mexican author, Juan Rulfo. The design of this multimedia product targeted both top-down and bottom-up processing in reading, i.e. hypothesis-testing and decoding and therefore included: (1) pre-reading strategies shown to increase comprehension for foreign language students, as well as (2) supplemental material to augment their socio-cultural background knowledge and (3) an interactive glossary to provide them with definitions of unknown vocabulary. These multimedia materials were pressed into CD-ROMs for an experimental study carried out with students in the intermediate Spanish course at the University of Pennsylvania., to see if the multimedia program had a positive effect on learning. Four assessments of learning gains were carried out with a control group and an experimental multimedia group. These measurements were: (1) comprehension quiz; (2) an immediate vocabulary recall measurement; (3) a test of recall of the narrative two weeks following the reading; and (4) a delayed vocabulary recall measurement two weeks after the study. Students also answered a questionnaire reporting on the aspects they liked or disliked in the multimedia program and what aspects of the technology appeared to aid or hinder their reading. The study found that this particular multimedia program was successful in assisting students\u27 reading comprehension of the foreign language text. The multimedia group scored particularly higher than the control group in questions requiring the use of inference, analysis and synthesis in reading. With regards to the students\u27 acquisition of new vocabulary words, the students who used the interactive glossary showed a statistically significant improvement over the control group but the number of vocabulary words acquired was quite small. Both delayed assessments, the recall of the narrative and the recall of vocabulary did not show significant differences between groups

Interleukin-7 and Immunosenescence

The age of an individual is an important, independent risk factor for many of the most common diseases afflicting modern societies. Interleukin-7 (IL-7) plays a central, critical role in the homeostasis of the immune system. Recent studies support a critical role for IL-7 in the maintenance of a vigorous healthspan. We describe the role of IL-7 and its receptor in immunosenescence, the aging of the immune system. An understanding of the role that IL-7 plays in aging may permit parsimonious preventative or therapeutic solutions for diverse conditions. Perhaps IL-7 might be used to “tune” the immune system to optimize human healthspan and longevity

Decreased energy availability during training overload is associated with non-functional overreaching and suppressed ovarian function in female runners

Low energy availability (EA) suppresses many physiological processes, including ovarian function in female athletes. Low EA could also predispose athletes to develop a state of overreaching. This study compared the changes in ad libitum energy intake (EI), exercise energy expenditure (ExEE), and EA among runners completing a training overload (TO) phase. We tested the hypothesis that runners becoming overreached would show decreased EA, suppressed ovarian function and plasma leptin, compared to well-adapted (WA) runners. After 1 menstrual cycle (baseline), 16 eumenorrheic runners performed 4 weeks of TO followed by a 2-week recovery (1313% and 636% of baseline running volume respectively). Seven-day ExEE, EI, running performance (RUNPERF) and plasma [leptin] were assessed for each phase. Salivary [estradiol] was measured daily. Urinary [luteinizing hormone] tests confirmed ovulation. Nine runners adapted positively to TO (WA,ΔRUNPERF: +42%); seven were non-functionally overreached (NFOR, ΔRUNPERF –92%) as RUNPERF remained suppressed after the recovery period. WA increased EI during TO, maintaining their baseline EA despite a large increase in ExEE (ΔEA=+1.91.3 kcal.kgFFM-1.d-1, P=0.17). By contrast, NFOR showed no change in EI, leading to decreased EA (ΔEA=-5.62.1 kcal.kgFFM-1.d-1, P=0.04). [Leptin]b, mid-cycle and luteal [estradiol]s decreased in NFOR only. Contrasting with WA, NFOR failed to maintain baseline EA during TO, resulting in poor performance outcomes and suppressed ovarian function.NCT02224976. NOVELTY BULLETS: -Runners adapting positively to training overload (TO) increased ad libitum energy intake, maintaining baseline EA and ovarian function through TO. -By contrast, NFOR runners failed to increase energy intake, showing suppressed EA and ovarian function during TO.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Inability of Primary Care Providers to Predict Medication Fulfillment of New Prescriptions

Background/Aims: Physician prediction of patient medication adherence to chronic therapy is unreliable, but the accuracy of physician predictions is largely unstudied for new prescriptions. Our aim was to determine if provider perception of the likelihood a patient will pick up a medication is an accurate predictor of primary medication nonadherence. Methods: We conducted a prospective cohort study as part of a randomized clinical trial. Providers at 24 primary care and family medicine Geisinger clinics were asked to complete a “best practice alert” (BPA) within the electronic health record when placing an order for a new antihypertensive, antidiabetic, antihyperlipidemic or antiasthmatic medication. The BPA asked: “In your opinion, how likely is it that this patient will pick up this medication?” The provider could select from a 5-level Likert item with responses ranging from “very unlikely” to “very likely.” Provider response was correlated to the principle outcome variable, medication first fill after 14 days as identified from the records of the pharmacy to which the prescription was transmitted. Results: A total of 4,822 patients over 11 months were included, and 4,532 (94%) patients filled their prescription within 14 days. Providers answered the BPA 89% of the time. Among respondents, most felt their patients would be likely or very likely to pick up their new medication (90.6% vs. 86.8% of providers chose likely or very likely among adherent and nonadherent groups, respectively). Only 10 (3.9%) of new medication orders not filled (nonadherent) versus 110 (2.7%) filled (adherent) were suspected by providers to be unlikely or very unlikely to be picked up, resulting in only an 8.3% positive predictive value for primary medication nonadherence. Discussion: Our study suggests that physicians overwhelmingly believe their patients are likely/very likely to pick up their first prescription. A physician’s intuition about a patient’s likelihood of filling a new medication does not reliably identify patients who do not fill new prescriptions for chronic medications. Our study’s ability to assess prediction accurately is limited by the unusually high first-fill rate of patients in this trial. Our findings are congruent with other reports assessing physician perceptions of patient adherence to chronic medications