A five-year study of prevention of scuba-diving morbidity in a university training program.
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OBJECTIVE: To examine the task-nonspecific effects of functional neuromuscular stimulation (FNS)-assisted ambulation training on the physiological responses of persons with paraplegia to upper extremity exercise challenge. DESIGN: Before-after trial. SETTING: Human spinal cord injury (SCI) applied research laboratory. PARTICIPANTS: Twelve men and three women with motor- and sensory-complete thoracic-level SCI (T4-T11), mean age 28.2 +/- 6.8yrs (range, 21.1 to 45.2yrs), mean injury duration 3.7 +/- 3.0yrs (range, 7 to 8.8yrs). INTERVENTION: Thirty-two sessions of FNS ambulation training using a commercial six-channel system (Parastep 1). This system is composed of a microprocessor-controlled electrical stimulation unit and a walking frame outfitted with finger switches that allow the user to independently control the system and stimulation parameters. OUTCOME MEASURES: Peak and subpeak physiological responses to arm ergometry testing and upper extremity strength measures, obtained before and after the FNS ambulation training. RESULTS: Statistically significant increases in peak values for time to fatigue, peak power output, and peak VO2 (all p < .001). Heart rate was significantly lower throughout subpeak levels of arm ergometry after the ambulation training (p < .05). Values of upper extremity strength were not significantly altered after training. CONCLUSIONS: FNS ambulation by persons with SCI paraplegia results in task-nonspecific training adaptations. Central cardiovascular adaptations were indicated as the primary source of these beneficial alterations in exercise responses.
BACKGROUND: Respiratory muscle weakness may contribute to dyspnea and exercise limitation in patients with significant COPD. In an attempt to reduce the severity of breathlessness and to improve exercise tolerance, inspiratory muscle training has been applied in many COPD patients. On the other hand, there is a paucity of data related to expiratory muscle performance and training in COPD. METHODS: Thirty-two patients with significant COPD (ie, mean FEV(1), 37% of predicted) were recruited for the study. The patients were randomized into four groups: eight patients were assigned to receive specific expiratory muscle training (SEMT); eight patients received specific inspiratory muscle training (SIMT); eight patients received SEMT and SIMT (ie, the SEMT + SIMT group); and eight patients who were assigned to a control group received training with very low load. All patients trained daily, six times a week, with each session consisting of one half hour of training, for 3 months. Spirometry, respiratory muscle strength and endurance, 6-min walk test distance, the perception of dyspnea, and the Mahler baseline dyspnea index (BDI) were measured before and following training. RESULTS: Training caused a statistically significant specific increase in the expiratory muscle strength and endurance (in the SEMT and SEMT + SIMT groups) and in the inspiratory muscle strength and endurance (in the SIMT and SEMT + SIMT groups). There was significant increase in the distance walked in 6 min in the SEMT, SIMT, and SEMT + SIMT groups. However, the increase in the SIMT and SEMT + SIMT groups was significantly greater than that in the SEMT group. There was a statistically significant increase in the BDI, and a decrease in the mean Borg score during breathing against resistance in the SIMT and SEMT + SIMT groups, with no changes in the SEMT and control groups. CONCLUSIONS: The inspiratory and expiratory muscles can be specifically trained with improvement of both muscle strength and endurance. The improvement in the inspiratory muscle performance is associated with an increase in the 6-min walk test distance and the sensation of dyspnea. There is no additional benefit gained by combining SIMT with SEMT, compared to using SIMT alone.
OBJECTIVE: The aim of this paper is to chart the ethical territory surrounding the issue of consensual sexual relationships between psychiatrists and doctors training in psychiatry. METHOD: The arguments for and against the prohibition of such relationships are critically examined both in general and in a number of specific circumstances. RESULTS: There should not be a general prohibition against such relationships, but a prohibition should apply in certain special circumstances. Such circumstances include occasions when the psychiatrist is currently supervising the trainee, when a particular psychiatrist has repeated sexual relationships with trainees and when a group of psychiatrists voluntarily pledge to abstain from such relationships. CONCLUSIONS: Institutions involved in psychiatric training should develop guidelines for dealing with such relationships, adopting a generally permissive attitude toward them with clear exceptions in special cases.
Used Carkhuff's Indices of Communication and Discrimination along with other measures to assess the level of communication and discrimination skills at various stages of communication training. Ss were 14 male and 9 female students in a psychology of adjustment class. Results indicated that: (a) treatment and control groups did not differ in communication skills before they went through training; (b) the treatment group offered higher levels of communication skill after it had completed training than did the control group before it began training; (c) the control group offered levels of communication skill equal to those of the treatment group once the control group also had completed training. A similar pattern was found for discrimination skill. The effects of training cannot be dismissed as paper-and-pencil artifacts because others who were ignorant of the growth conditions concept reacted differently in brief unstructured interactions to those who had completed training.
In the past 2 decades, international medical graduates (IMG) were needed to fill graduate medical education (GME) positions in the United States (U.S.). The author built a database of Thai medical graduates in accredited U.S. residency systems between 1988-2003, and analyzed the trend and opportunity for Thai IMG. During the 16-year study period, there were 281 Thai medical graduates who successfully entered residency in the U.S., with a rising trend that reached a peak between 1993-1994, and subsequently declined to about 10-15 per year Thai physicians entered U.S. residency program 4.2 +/- 3.3 years after medical school graduation. Thai IMGs were mostly in internal medicine (N=153, 54.4%) and pediatric residency programs (N=76, 27.1%), with much fewer in psychiatry (N=10), surgery (N=9), neurology (N=8), anesthesiology (N=7), and other specialties (N=18). Thai medical graduates tended to be clustered in a few residency programs. Half of the Thai graduates in the U.S. internal medicine residency were accepted in 9 programs; the largest were Texas Tech (Lubbock, N=18), Albert Einstein University (Philadelphia, N=14), and University of Hawaii (Honolulu, N=13). For pediatric residency, about half of the Thai graduates (56.6%) were in 6 programs; the largest were Christ Hospital (Oaklawn, N=11), University of Illinois at Chicago (N=11), and Jersey City Medical Center (N=9). After residency training, most Thais (94.5%) chose to do subspecialty training. The most popular medical subspecialties were cardiology, nephrology, and hematology-oncology. The most popular pediatric subspecialties were allergy-immunology, endocrinology, and cardiology. In conclusion, there are too few Thais in the U.S. residency system. This information may be helpful for Thai medical graduates who seek residency abroad.
The Department of Preventive Medicine of the University of the West Indies was established in 1957 with the idea of improving undergraduate teaching facilities to enable medical students to study patients in their homes and social environment. The authors describe the two public health diploma programs available at the University and cite pertinent enrollment and geographic distribution statistics. Candidates for the Diploma in Public Health are registered medical practitioners who take a series of compulsory and elective subjects and have a period of supervised field training and research during the 12-month course. The Diploma in Community Health trains students in the health and diseases of man in his total environment. Students choose among three program options: the general program, specialization in health education, or specialization in health services administration/hospital administration. The general program is the most popular because it gives the student a rounded education suitable to the needs of small states. The 12-month diploma course features the interdisciplinary approach where students from various fields discuss important issues in community health. Comprehensive courses in these areas include health services administration, social sciences, environmental health, epidemiology and biostatistics, family health, communication science, and community mental health. The authors state that the candidate for the Diploma in Community Health is assessed on the basis of course and field work, a special project report, and a final written and oral examination.
The purposes of this investigation were to document the changes in stride length of college-age male novice runners (n = 13) who were allowed of freely choose their stride length throughout a 7-week training period (FCSL), and to compare subsequent changes in running economy to those observed in a similar group of runners (n = 13) that ran for 7 weeks with constant stride lengths equivalent to their initially chosen stride lengths (CSL). Subjects trained 3 days per week for approximately 7 weeks (22 training bouts). Each training bout consisted of a minute warmup (60% VO2max) and a 15-minute run at a speed equivalent to 80% of the subjects' initial VO2max. Absolute stride length (ASL), heart rate (HR), and ratings of perceived exertion (RPE) were measured during the 12th and 20th minute of exercise. Relative and absolute submaximal VO2 were measured during the 4th and 22nd training bout. No significant differences in percent change in ASL were found between the groups or across the weeks of training at the 12th or 20th minute of exercise; however, there was a significant difference (p less than or equal to .05) between the groups during the 4th week of training. No significant differences were found between the groups in relative or absolute submaximal VO2. Relative submaximal VO2 at the 12th minute of exercise decreased significantly following the training period in both the FCSL (-3.38%) and CSL (-4.32%) groups. Absolute submaximal VO2 did not change significantly following the training period.(ABSTRACT TRUNCATED AT 250 WORDS)
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