The effect of tactile and verbal guidance during scapulothoracic exercises: An EMG and kinematic investigation.

BACKGROUND: Clinician-led training through tactile and verbal guidance to improve muscle activity and joint motion are a common but understudied focus of therapeutic interventions for shoulder pain. The purpose of this study was to determine if clinician guidance changes scapulothoracic muscle activity and kinematics compared to unguided shoulder exercises. METHODS: Eleven participants with shoulder pain were studied. Electromyographic (EMG) sensors were placed on the serratus anterior and upper and lower trapezii. Scapulothoracic and sternoclavicular kinematics were collected using electromagnetic sensors. Five common resisted shoulder exercises were performed with the following guidance: unguided, combined (verbal and tactile cues), and verbal guidance only. One-way repeated measures ANOVAs determined the effect of guidance versus unguided conditions for each exercise. RESULTS: Nine of ten combinations of exercise and guidance techniques demonstrated a significant effect of guidance for either muscle activity or joint kinematics. The guidance condition with the most frequent significant improvements across all variables was the combined condition. The exercises with the most frequent significant improvements across all variables were the external rotation exercises. Variables improved most frequently were: upper:lower trapezius EMG ratio (up to 11%), sternoclavicular elevation (up to 6°) and scapulothoracic internal rotation positioning (up to 8°), and sternoclavicular retraction displacement (up to 5°). CONCLUSION: Shoulder muscle activity and kinematics during exercises can be modified by tactile and verbal guidance. Most improvements in muscle activity occurred with verbal guidance during external rotation exercises. Most improvements in joint positioning and movement occurred with combined guidance during external rotation exercises.

Photosensitized degradation of caffeine: role of fulvic acids and nitrate.

The photolysis of caffeine was studied in solutions of fulvic acid isolated from Suwannee River, GA (SRFA) and Old Woman Creek Natural Estuarine Research Reserve, OH (OWCFA) with different chemical amendments (nitrate and iron). Caffeine degrades slowly by direct photolysis (>170 h in artificial sunlight), but we observed enhanced photodegradation in waters containing the fulvic acids. At higher initial concentrations (10 µM) the indirect photolysis of caffeine occurs predominantly through reaction with the hydroxyl radical (OHⁱ) generated by irradiated fulvic acids. Both rate constant estimates based upon measured OHⁱ steady-state concentrations and quenching studies using isopropanol corroborate the importance of this pathway. Further, OHⁱ generated by irradiated nitrate at concentrations present in wastewater effluent plays an important role as a photosensitizer even in the presence of fulvic acids, while the photo-Fenton pathway does not at neutral or higher pH. At lower initial concentrations (0.1 µM) caffeine photolysis reactions proceed even more quickly in fulvic acid solutions and are influenced by both short- and long-lived reactive species. Studies conducted under suboxic conditions suggest that an oxygen dependent long-lived radical e.g., peroxyl radicals plays an important role in the degradation of caffeine at lower initial concentration.

Fulvic acid mediated photolysis of ibuprofen in water.

Photolysis of the non-steroidal anti-inflammatory drug ibuprofen was studied by exposure to a solar simulator in solutions of fulvic acid (FA) isolated from Pony Lake, Antarctica; Suwannee River, GA, USA; and Old Woman Creek, OH, USA. At an initial concentration of 10 µM, ibuprofen degrades by direct photolysis, but the presence of FA significantly increases reaction rates. These reactions proceeded up to 6× faster in FA solutions at lower ibuprofen concentrations (0.1 µM), but the rates are highly dependent upon DOM composition. Incomplete quenching of the reaction in the presence of isopropanol suggests that the hydroxyl radical is only partially responsible for ibuprofen's photodegradation in FA solutions, and other reactive transients likely play an important role. Liquid chromatography-quadrupole time-of-flight mass spectrometry and NMR spectroscopy reveal the formation of multiple photoproducts, with three byproducts identified as 1-(4-isobutylphenyl)ethanol, isobutylacetophenone, and a phenol derivative. Pony Lake FA significantly increases the production of the major byproduct relative to yields produced by direct photolysis and the other two FA. Thus, the photolytic fate of ibuprofen in sunlit waters is affected by its initial concentration and the source of dissolved organic matter present.

Direct and indirect photolysis of polycyclic aromatic hydrocarbons in nitrate-rich surface waters.

The photolysis of three polycyclic aromatic hydrocarbons (PAHs)-pyrene, phenanthrene, and naphthalene-were studied in waters taken from creosote-contaminated sites in Gary (IN, USA) and Wilmington (NC, USA). Direct photolysis of all PAHs was observed under simulated solar radiation, with pyrene degrading at a faster rate than either phenanthrene or naphthalene. Phenanthrene degradation, when compared to its direct photolysis rate, increased in Gary water but decreased in Wilmington water. Analysis of the waters for dissolved organic carbon (DOC) and nitrate revealed higher levels of DOC in the Wilmington sample (9.29 mg/L) compared with the Gary sample (6.73 mg/L), as well as significantly less nitrate (0.046 mM vs 0.205 mM for the Gary sample). The slightly lower rate of phenanthrene degradation observed for the Wilmington sample, corrected for light attenuation effects, is statistically the same as that in the direct photolysis experiments. Therefore, we attribute the lower rate of degradation in the presence of Wilmington water to light screening by DOC, but we believe the faster reaction rate observed for the Gary water results from hydroxyl radical (OH*) chemistry generated by nitrate photolysis. Indeed, degradation of the target compound increased when nitrate (at 0.2 and 0.4 mM) was added to the Wilmington sample, further corroborating this conclusion. Overall photoreaction rates decreased for the lower-molecular-weight PAHs, because the fastest naphthalene photolytic rate was roughly two orders of magnitude slower than that of pyrene.