Biomedical subjects
J Alter
Publications and source records attributed to J Alter.
Progress, sort of. Health reform: is that a light at the end of the tunnel, or Bob Dole's grin?
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Progress and promise.
Efforts to control costs and improve quality are working. Now Congress will determine how best to control future health care costs and extend care to the nation's uninsured.
Glucose polymer ingestion--effect on fluid balance and glycemic state during a 4-d march.
The effect of glucose-polymer solution on physical performance has been extensively studied under controlled laboratory conditions. The present study was conducted to investigate the influence of such beverages on fluid balance and on glycemic state during a moderate, prolonged field exercise. Forty-eight endurance trained, male subjects participated in the study. The maneuver consisted of a 4-d march; 29, 39, 36, 30 km.d-1, at a speed of 5-6 km.h-1. The subjects covered a total distance of 134 km at an estimated exercise intensity of approximately 40% VO2max, under hot climate conditions (ambient temperature, 32-41 degrees C; relative humidity, 60-14%). Subjects were randomly assigned to one of two groups: glucose polymer-electrolyte beverage (GP; N = 24) and tap water (TW; N = 24). Each group was then divided into two subgroups consuming fluid ad libitum (TWa, GPa) or instructed to consume 900 ml.h-1 (TWb, GPb). The mean daily fluid consumption of all subgroups was similar (5252 +/- 229 and 4640 +/- 67 ml in TWa and TWb; 5257 +/- 317 and 5253 +/- 216 ml in GPa and GPb, respectively). Weight loss, reflecting the degree of dehydration, was 1.2 +/- 0.1% and 1.9 +/- 0.3% of initial body weight in TW and GP, respectively. On day 1, plasma volume changed by +0.4% and -1.8% in the TW and GP groups, respectively. On the days 2-4 changes in both groups were similar.(ABSTRACT TRUNCATED AT 250 WORDS)
Go ahead, bust some chops.
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Physicians.
As government agencies, insurers, managed care organizations, and employers implement a growing number of regulations and requirements, physicians are being asked to fulfill many roles. In addition to treating patients they must now serve as quality assurance officers and patient advocates. Physicians are struggling to adapt to their new roles. In response to changing public expectations, medical school educators are also changing the way in which the physicians of tomorrow are being trained.
HMOs and insurers.
Managed care is a term that is unfamiliar to and misunderstood by many Americans. Nevertheless, as health care purchasers in the public and private sectors seek to buy affordable, quality health care, they are turning in greater numbers to various managed care plans. HMOs and insurers are adopting innovative methods with which to improve care of patients and streamline administration.
Rising to the challenge.
An overview of health care in America today. An estimated 37 million men, women, and children lack access to affordable health care. As the cost of medical care continues to rise, millions more face the possibility of joining the ranks of the uninsured. These problems must be addressed. But we also need to consider the many benefits that we derive from our health care system.
[Glucose polymer solutions and prolonged exertion in the heat].
The effect of glucose polymer solutions on physical performance has been extensively investigated, mainly under controlled laboratory conditions. The influence of such beverages on fluid balance and on glycemic state in the field, during prolonged exercise of moderate intensity (a 134 km march) in the heat (32-41 degrees C, 60-14% relative humidity) was therefore studied. 48 endurance-trained men were randomly assigned to drink either a 7.2% glucose polymer (GP) electrolyte beverage or tap water (TW); there were 24 in each group. Each group was then divided into subgroups that either consumed fluid ad libitum, or were instructed to consume 1000 ml/hr. Mean fluid consumption of all subgroups was similar. There was a greater change in plasma volume for the TW than for the GP group (+7.9% vs. +4.8%, respectively; p less than 0.05). However, in neither the GP nor the TP group did dehydration exceed 2% of body weight. Blood glucose concentration increased significantly in subjects ingesting GP (p less than 0.01) while it decreased on each day of march in those drinking TW. It is concluded that the fluid intake recommended at present by the IDF is adequate to maintain hydration within the normal range during physical effort in the heat. The differences between the GP and the TW groups in this study do not justify the substitution of glucose-polymer solutions for water during prolonged, moderate exercise.
The effect of caffeine ingestion on physical performance after prolonged exercise.
The purpose of this study was to determine the effect of caffeine ingestion on physical performance after prolonged endurance exercise. Twenty three trained male volunteers participated in a 40-km march and were divided into two groups, matched for caffeine clearance rate and aerobic capacity. The experimental group ingested, prior to the march, a caffeinated drink at a dose of 5 mg.kg-1 body mass and at the 3rd and 5th h of marching an additional drink at a dose of 2.5 mg.kg-1 body mass. The control group ingested a drink of equal volume at the same times. Upon termination of the march each subject performed a cycle ergometer test at an intensity of 90% maximal oxygen consumption. Time to exhaustion and rate of perceived exertion (RPE) were recorded. Blood samples were drawn predrink, at the 3rd and 5th h of marching and immediately after the cycle ergometer test, and were analysed for caffeine, free fatty acids (FFA), lactate and glucose levels. Plasma FFA levels increased during the march (p less than 0.05), with no significant difference between groups. Lactate levels increased in the experimental group (p less than 0.05), with no significant change in the control group. Glucose levels did not change significantly in either group. After the cycle ergometer test, lactate levels were significantly higher in the experimental, as compared to the control group (3.77 +/- 0.33 vs 2.52 +/- 0.35 mmol.l-1, respectively). There was no significant difference between treatments in the time to exhaustion on the cycle ergometer, but RPE was different (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
The experts rate important features and outcomes of sex education programs.
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CPR training for everyone? At this hospital--yes.
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Further studies on the hemodynamics of tension on an abdominal incision.
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Cardiac dynamics of dl-propranolol (Inderal), d-propranolol, and practolol (AY 21011, ICI 50172): a preliminary study.
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Recklinghausen's disease with systemic manifestations and malignant changes: report of a case.
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Effects of irregular versus regular sleep schedules on performance, mood and body temperature.
Twelve male college students slept for 38 consecutive nights in the sleep laboratory under strict control of bedtime and wake-up time. Sleep logs, body temperature and performance on an experimenter-paced auditory vigilance and subject-paced addition test were assessed before sleeping in the laboratory, following 38 consecutive nights, and one month afterward to examine the effects of rigidly controlling retiring and awakening times. While large changes in the regularity of sleep occurred during sleep in the laboratory as compared to the normal irregular schedules, no significant changes in EEG sleep stage, performance, or mood were found. Body temperature was found to be higher and, perhaps, more flattened in the initial irregular condition as compared to the regular sleep schedule condition. It was concluded, however, that careful control of sleep and waking times in relatively irregular sleeping college students had little influence on sleep or performance. This finding implies that previous differences reported between groups of regular and irregular sleepers may have been based on personality differences rather than sleep scheduling factors.