Catalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation.

INTRODUCTION: Planned home or birth center births sometimes require emergency transfers to a hospital. Poor communication among members of the birth care team during a transfer can lead to unfavorable outcomes for the birthing person and newborn. To improve the quality of birth transfers in Utah, the Utah Women and Newborns Quality Collaborative partnered with the LIFT Simulation Design Lab to develop and pilot an interprofessional birth transfer simulation training. METHODS: We engaged community stakeholders to identify learning objectives and co-design the simulation trainings using principles of participatory design. We conducted 5 simulation trainings featuring birth transfers during a postpartum hemorrhage. The LIFT Lab evaluated the trainings to determine if they were feasible, acceptable, and effective. Measures included a post-training form asking participants to evaluate the quality of the training and a 9-question pre- and post-training survey measuring changes in participants' self-efficacy regarding components of birth transfer. The changes were assessed for significance using a paired t test. RESULTS: A total of 102 participants attended the 5 trainings; all health care provider groups were well represented. Most participants felt the simulations were similar to real situations and would benefit others in their professions. All participants said the trainings were a good use of their time. Following the training, participants had significantly higher levels of self-efficacy regarding their ability to manage birth transfers. DISCUSSION: Birth transfer simulation trainings are an acceptable, feasible, and effective method for training interprofessional birth care teams.

Acute beetroot juice reduces blood pressure in young Black and White males but not females.

A complex interplay of social, lifestyle, and physiological factors contribute to Black Americans having the highest blood pressure (BP) in America. One potential contributor to Black adult's higher BP may be reduced nitric oxide (NO) bioavailability. Therefore, we sought to determine whether augmenting NO bioavailability with acute beetroot juice (BRJ) supplementation would reduce resting BP and cardiovascular reactivity in Black and White adults, but to a greater extent in Black adults. A total of 18 Black and 20 White (∼equal split by biological sex) young adults completed this randomized, placebo-controlled (nitrate (NO3-)-depleted BRJ), crossover design study. We measured heart rate, brachial and central BP, and arterial stiffness (via pulse wave velocity) at rest, during handgrip exercise, and during post-exercise circulatory occlusion. Compared with White adults, Black adults exhibited higher pre-supplementation resting brachial and central BP (Ps ≤0.035; e.g., brachial systolic BP: 116(11) vs. 121(7) mmHg, P = 0.023). Compared with placebo, BRJ (∼12.8 mmol NO3-) reduced resting brachial systolic BP similarly in Black (Δ-4±10 mmHg) and White (Δ-4±7 mmHg) adults (P = 0.029). However, BRJ supplementation reduced BP in males (Ps ≤ 0.020) but not females (Ps ≥ 0.299). Irrespective of race or sex, increases in plasma NO3- were associated with reduced brachial systolic BP (ρ = -0.237, P = 0.042). No other treatment effects were observed for BP or arterial stiffness at rest or during physical stress (i.e., reactivity); Ps ≥ 0.075. Despite young Black adults having higher resting BP, acute BRJ supplementation reduced systolic BP in young Black and White adults by a similar magnitude, an effect that was driven by males.

Habituation attenuates the sex-specific associations between ischemic pain, blood pressure, and arterial stiffness in young adults.

Cardiovascular reactivity (CVR) during physical stress is prognostic for incident cardiovascular disease. CVR is influenced by perceived pain. However, there is limited data on the effect of sex differences and repeated exposures to painful stimuli on CVR. We measured blood pressure (BP) and carotid-femoral pulse wave velocity (cf-PWV; an index of arterial stiffness) at rest, during isometric handgrip (HG) exercise at 30% of maximum voluntary contraction, and during postexercise circulatory occlusion (PECO) during two identical trials in 39 adults (20M/19F; 18-39 yr). We assessed participants' perceived pain using a visual analog scale after the first minute of each stimulus. We collected BP during minute 2 of each stimulus and cf-PWV during minute 3 of each stimulus. In male participants, we observed moderate associations (Ps ≤ 0.023) between perceived pain and changes in brachial diastolic (ρ = 0.620) and mean BP (ρ = 0.597); central diastolic, mean, and systolic BP (ρs = 0.519-0.654); and cf-PWV (ρ = 0.680) during PECO in trial 1, but not trial 2 (Ps ≥ 0.162). However, in female participants, there were no associations between pain and CVR indices during either trial (Ps ≥ 0.137). Irrespective of sex, reductions in perceived pain during trial 2 relative to trial 1 were weakly to moderately associated (Ps ≤ 0.038) with reductions in brachial diastolic (ρ = 0.346), mean (ρ = 0.379), and systolic BP (ρ = 0.333); central mean (ρ = 0.400) and systolic BP (ρ = 0.369); and cf-PWV (ρ = 0.526). These findings suggest that 1) there are sex differences in pain modulation of CVR in young adults and 2) habituation blunts pain and CVR during PECO, irrespective of sex.NEW & NOTEWORTHY We demonstrate sex differences in the association between pain perception and cardiovascular reactivity (CVR) during ischemic pain. We also demonstrate habituation to pain and reduced CVR during repeated exposure in a sex-independent manner. Accounting for sex differences and habituation may improve the prognostic utility of CVR.

Self-recorded heart rate variability profiles are associated with health and lifestyle markers in young adults.

PURPOSE: To quantify associations between self-recorded heart rate variability (HRV) profiles and various health and lifestyle markers in young adults. METHODS: Otherwise healthy volunteers (n = 40, 50% male) recorded 60-s, post-waking HRV with a cost-free mobile application in supine and standing positions for 7 days. The 7-day average and coefficient of variation (CV, reflects daily fluctuation) for the mean RR interval and root mean square of successive differences (LnRMSSD) were assessed. 7-day sleep duration and physical activity profiles were characterized via wrist-worn accelerometer. Subsequent laboratory assessments included aerobic fitness ([Formula: see text]O2peak) and markers of cardiovascular, metabolic, and psychoemotional health. Associations were evaluated before and after [Formula: see text]O2peak adjustment. RESULTS: Bivariate correlations (P < 0.05) demonstrated that higher 7-day averages and/or lower CV values were associated with higher activity levels and superior cardiovascular (lower systolic and diastolic blood pressure [BP] and aortic stiffness [cf-PWV]), metabolic (lower body fat percentage, fasting glucose, and low-density lipoprotein cholesterol [LDL-C]), and psychoemotional health (lower perceived stress) markers, with some variation between sexes and recording position. In males, associations between HRV parameters and cf-PWV remained significant following [Formula: see text]O2peak adjustment (P < 0.05). In females, HRV parameters were associated (P < 0.05) with numerous cardiovascular (systolic and diastolic BP, cf-PWV) and metabolic (fasting glucose and LDL-C) parameters following [Formula: see text]O2peak adjustment. CONCLUSIONS: Higher or more stable supine and standing HRV were generally associated with superior health and lifestyle markers in males and females. These findings lay groundwork for future investigation into the usefulness of self-recorded ultra-short HRV as a health-promoting behavior-modification tool in young adults.

Cardiorespiratory Fitness Is Inversely Associated With Aortic Arterial Stiffness in Firefighters.

OBJECTIVES: The aim of this study was to determine whether cardiorespiratory fitness (CRF), expressed as VO 2 max (mL/kg/min), is associated with resting AS (carotid-femoral pulse wave velocity [cf-PWV]) and the AS response to simulated fire suppression activities in firefighters. METHODS: In firefighters (n = 20, 34 ± 8 years), AS was determined using cf-PWV (m/s) before and after a fire simulation exercise. VO 2 max was determined using a standard treadmill protocol. Linear regression models, adjusted for body fat percentage, are reported as unstandardized (b) and standardized (ß) betas (effect sizes). RESULTS: H1: there was a moderate (ie, ß = 0.5-0.8), inverse association between cf-PWV and VO 2 max (b = -0.80; 95% confidence interval [CI], -0.14 to -0.02; ß = 0.71). H2: there was a moderate, positive association between ∆cf-PWV and VO 2 max (b = 0.05; 95% CI, 0.00-0.10; ß = 0.62). CONCLUSIONS: These findings indicate that CRF may protect against arterial stiffening in firefighters.

Sleep duration irregularity is associated with elevated blood pressure in young adults.

Sleep irregularity (i.e., highly variable sleep patterns) is an emerging risk factor for cardiometabolic disease. Though irregular sleep patterns are common among young adults, the cardiometabolic health (CMH) repercussions of sleep irregularity in this population are unclear. We examined associations between sleep duration and irregularity with measures of CMH in 44 (24 M/20 F, 23 ± 5y, BMI 26 ± 4 kg/m2, blood pressure (BP): 125/71 ± 14/9 mmHg) young adults. Participants wore actigraphy monitors for seven-days and sleep duration irregularity was operationalized as the standard deviation of nightly sleep duration (sleep SD). CMH variables of interest included brachial and aortic BP, arterial stiffness (cf-PWV), augmentation index (AIx75), and fasting blood glucose and lipids. Associations between sleep duration and sleep SD with CMH variables were assessed via correlations adjusted for sex and BMI. Sleep duration generally was not associated with CMH indices. However, sleep SD was associated with brachial systolic (r = 0.433, p = .027) and diastolic BP (r = 0.415, p = .035). Similarly, sleep duration SD was associated with aortic systolic BP (r = 0.447, p = .022). Our findings show that sleep irregularity, but not duration, is associated with higher brachial and central BP in young adults.Abbreviations: AIx75: augmentation index at a heart rate of 75 beats per minute; BP: blood pressure; CMH: cardiometabolic health; cf-PWV: carotid-femoral pulse wave velocity; DXA: dual x-ray absorptiometry; mg/dl: milligrams per deciliter; PWA: pulse wave analysis; PWV: pulse wave velocity; sleep duration SD: standard deviation of nightly sleep duration.

Nutritional habits of adolescent tennis players pre-, during, and post-match play.

BACKGROUND: Adolescence is accompanied by unique nutritional needs that must be addressed to support healthy growth and development. Energy intake and nutrient needs are exaggerated by athletic participation, and thus special attention to dietary choices in adolescent athletes is warranted. We investigated the nutritional habits of competitive adolescent tennis players. METHODS: Forty-five athletes (14F/31M, 15.7±1.7yrs) completed an online nutrition questionnaire investigating pre-, during, and post-match food and drink choices, and the primary decision maker and reasoning behind these choices. RESULTS: The day before match play, 29% of athletes reported carbohydrate (CHO) dominant meals. Water (98%), sports drink (73%), granola or protein bar (42%), and banana (36%) consumption were the most reported fueling options during match play. For matches >2h, 64% of players reported consuming a sports beverage and 21% supplemented with other CHO food items. Regarding hydration strategy, 87% of players reported not having a targeted fluid consumption goal and 69% reported gauging their hydration intake during a match according to thirst. The day after a match, 38% of players reported returning to a normal diet. The majority of adolescent athletes (76%) reported themselves as the primary decision maker of food choices rather than the parent/guardian or coach. Availability (62%), rather than performance (38%), was the primary rationale behind food and drink choices. CONCLUSIONS: Findings show wide variation in eating and drinking habits in competitive adolescent tennis players pre-, during, and post-match-play, with an opportunity for improved sports nutrition application.

Physical fitness, but not physical activity, is associated with mental health in apparently healthy young adults.

BACKGROUND: The prevalence of mental health disorders is rising globally. Despite the popularity of exercise as a strategy to improve mental health in individuals with anxiety or depression, there is a paucity of literature on this topic in apparently healthy young individuals who are free from mental illness. METHODS: We characterized relationships between actigraphy-derived physical activity levels and cardiorespiratory fitness (V̇O2max; via maximal graded exercise testing), with mental health assessed using psychometric questionnaires (POMS and PSS) in apparently healthy young adults (26±4.3yrs; 22 women and 26 men). RESULTS: In women and men combined, relative V̇O2max (33.5±8.1 mL/kg/min) was associated (P<0.01) with POMS (r=-0.454) and PSS (r=-0.510) scores, and relationships between fitness and POMS were preserved (P<0.05) after controlling for body fat (27.2±9.9%). Additionally, V̇O2max was associated (P<0.05) with numerous POMS subcomponents (tension, anger, fatigue, depression, confusion; all P<0.05). No relationships (P>0.05) were observed between physical activity profiles (sedentary time, light intensity time, moderate-vigorous intensity time, total steps, counts per day) with POMS or PSS scores, and only total steps was associated with relative V̇O2max (r=0.331; P=0.021). Relationships between relative V̇O2max and POMS scores were also observed in men (r=-0.407, P=0.039) and women (r=-0.490; P=0.021) individually, but V̇O2max and PSS relationships were exclusive to men (r=-0.516, P=0.007). CONCLUSIONS: Independent of body composition, cardiorespiratory fitness, but not actigraphy-derived physical activity, is associated with mental health in apparently healthy young men and women. To maximize mental health benefits, exercise training interventions are advised to focus on eliciting improvements in cardiorespiratory fitness.

Evidence for the Contribution of Gut Microbiota to Age-Related Anabolic Resistance.

Globally, people 65 years of age and older are the fastest growing segment of the population. Physiological manifestations of the aging process include undesirable changes in body composition, declines in cardiorespiratory fitness, and reductions in skeletal muscle size and function (i.e., sarcopenia) that are independently associated with mortality. Decrements in muscle protein synthetic responses to anabolic stimuli (i.e., anabolic resistance), such as protein feeding or physical activity, are highly characteristic of the aging skeletal muscle phenotype and play a fundamental role in the development of sarcopenia. A more definitive understanding of the mechanisms underlying this age-associated reduction in anabolic responsiveness will help to guide promyogenic and function promoting therapies. Recent studies have provided evidence in support of a bidirectional gut-muscle axis with implications for aging muscle health. This review will examine how age-related changes in gut microbiota composition may impact anabolic response to protein feeding through adverse changes in protein digestion and amino acid absorption, circulating amino acid availability, anabolic hormone production and responsiveness, and intramuscular anabolic signaling. We conclude by reviewing literature describing lifestyle habits suspected to contribute to age-related changes in the microbiome with the goal of identifying evidence-informed strategies to preserve microbial homeostasis, anabolic sensitivity, and skeletal muscle with advancing age.

Effect of a Commercially Available Low-Dose Capsaicin Supplement on Knee Extensor Contractile Function.

Capsaicin, the active pungent ingredient in chili peppers and various spicy foods, is demonstrated to influence a variety of physiological systems including skeletal muscle. The purpose of this study was to examine if a chewable capsaicin supplement (1.2 mg) could enhance isokinetic knee extensor contractile performance. Nine young, recreationally active individuals (5 females/4 males; 23.6 ± 1.5 yrs; 24.2 ± 3.3 kg/m2) participated in this randomized, single-blind crossover study. Following a familiarization session, participants completed two isokinetic knee extensor contractile function assessments, 45 minutes after ingesting either a capsaicin fruit gummy or eucaloric placebo, the order of which was randomized. Knee extensor peak torque (strength), summed torque (endurance) and fatigue index (fatigue) were compared between trials. Knee extensor peak torque was significantly greater (p < 0.05; d = 0.80) in the capsaicin (126.0 ± 40.4 N·m-1) than the placebo (118.8 ± 41.3 N·m-1) trial. No significant differences (p > 0.05) were found for summed torque (8012 ± 2771 vs. 7823 ± 2611 N·m-1; d = 0.45) or fatigue index (56.0 ± 17.1 vs. 48.7 ± 21.0 %; d = 0.46) between capsaicin and placebo trials, respectively. These findings, in a relatively modest and mixed-gender sample, suggest that pre-exercise capsaicin ingestion may benefit knee extensor muscle strength but does not appear to affect parameters of skeletal muscle endurance or fatigue.

Laboratory and Benchtop Performance of a Mealtime Insulin-Delivery System.

BACKGROUND: A basal bolus insulin regimen requires multiple daily insulin injections, which might discourage patient adherence. As a potential solution, a mealtime insulin-delivery system-a 3-day wearable bolus-only patch-was designed to manually administer mealtime insulin discreetly by actuating buttons through clothing, without the need for multiple needle sticks. METHOD: Extensive functional testing of the patch included dose accuracy (from initial fill of the device to empty), pressure-vacuum leak testing, last-dose lockout and occlusion detection (safety alert features that lock the dosing buttons when no insulin is delivered), assessments of insulin drug stability, toxicological risk (including chemical testing), and system biocompatibility. RESULTS: Dosing accuracy was 2 units ±10% (with U-100 insulin) over a range of environmental conditions, with ≥95% reliability and confidence. The fluid seal performance and the safety alert features performed with ≥95% reliability and ≥95% confidence. The system met acceptable standards for insulin (U-100 lispro and aspart) stability for its intended 3-day use, in addition to the operational requirements. The toxicological risk assessment and demonstrated biocompatibility suggested that the patch is safe for human use. CONCLUSIONS: Benchtop performance showed that the bolus-only patch is a safe, accurate, and reliable device for mealtime insulin delivery.

Patient Perceptions and Preferences for a Mealtime Insulin Delivery Patch.

INTRODUCTION: A basal-bolus insulin regimen is needed to achieve glycated hemoglobin A1c (HbA1c) below 7.0% in people with type 1 (T1D) or type 2 (T2D) diabetes who have significant loss of beta-cell function. Nonadherence to therapy is common and negatively affects the ability to reach treatment goals. We examined patient assessment of a new, wearable mealtime insulin-delivery system (patch) relative to their current mealtime insulin-delivery system (syringe, pen, or pump). The patch is designed to deliver only boluses of fast-acting insulin (no basal insulin), mechanically controlled by the patient. METHODS: Adults (n = 101) with T1D or T2D assessed their current mealtime insulin-delivery system and then assessed simulated (no active medication) patch use over a 3-day period. Participants evaluated mealtime insulin-delivery systems using eight measures from five domains (convenience, interference with daily activities, diabetes-related worry, psychological well-being, and overall satisfaction/preference) on the self-administered Insulin Delivery System Rating Questionnaire. User ratings of their current insulin-delivery systems (syringe, pen, pump) were compared with those for the patch by repeated measure analysis of variance and one-sample t tests. RESULTS: Participants had significant (p < 0.05) preference for patch over syringe in all eight comparisons, and over pen in five out of eight comparisons, with no significant preference for pen. Although there was a preference for patch over pump in six out of eight comparisons, only one showed a significant preference for patch, and one for pump. Significantly more participants reported that they would like to switch to the patch than continue using a syringe (78% vs 22%) or pen (76% vs 24%) but this difference was not significant for the group using a pump (52% vs 48%). CONCLUSIONS: Participants preferred using the patch over pens and syringes. Its ease of use and discreet method of insulin delivery may contribute to improved patient adherence to mealtime insulin regimens among people currently using injection devices. FUNDING: Calibra Medical.