Training status influences T-cell responses in women following acute resistance exercise.

The purpose of this investigation was to examine white blood cell counts (WBC), immunoglobulin (IgA, IgG, IgM) levels, and T-cell proliferation following acute resistance training in 9 untrained (UT) and 6 trained (TR) women. Resistance training on 7 Universal machines at the subject's 10 repetition maximum (IORM) was performed at 89 +/- 5% for UT and 88 +/- 3% for TR. Blood was analyzed for WBCs and Ig levels pre-exercise, immediately postexercise, and 1.5, 3, and 24 hours postexercise. T-cell proliferation was determined pre-exercise and 3 hours postexercise through response to phytohemagglutanin (PHA). WBCs were significantly elevated in the UT subjects 1.5 and 3 hours postexercise compared with pre- and immediately postexercise; no differences (p < 0.05) were observed in TR subjects. No significant differences were found for Ig levels either between or within groups, although there was a trend for decreased IgG following exercise. T-cell proliferation was significantly decreased in the UT at 3 hours postexercise (0.27 +/- 0.06 units) compared with pre-exercise (0.41 +/- 0.06 units), whereas the proliferative response in TR was not significantly different from pre-exercise (0.48 +/- 0.04 units) to 3 hours postexercise (0.34 +/- 0.06 units). These data indicate that UT subjects experience an increase in WBC counts and a decrease in T-cell proliferative ability after acute resistance training, whereas TR subjects experience no significant change in these parameters.

The effects of supplemental carbohydrate ingestion on intermittent isokinetic leg exercise.

BACKGROUND: The purpose of this investigation was to examine the effects of carbohydrate (CHO) supplementation on isokinetic leg extension/flexion exercise performance, blood glucose responses, blood free fatty acid (FFA) responses, and blood lactate (La) responses. METHODS: Eight resistance trained males (mean+/-SEM, age: 23.7+/-1.3 yrs, height: 180.0+/-3.5 cm, bodymass: 94.9+/-4.9 kg) participated in a randomized, double blind protocol with testing sessions separated by 7-d. Subjects were given CHO or placebo (P) while performing 16 sets of 10 repetitions at 120 degrees x s(-1) on a Cybex isokinetic dynamometer. Performance variables measured were; total work (TW), average work (AW), peak torque (PT) and average torque (AT). Plasma glucose (PG), FFA, and La were measured prior to testing (PRE), after set 8 (MID), and 16 (POST). RESULTS: Results indicated that the CHO treatment elicited significantly (p<0.05) more TW (CHO: 41.1+/-3.9 kJ; P: 38.1+/-3.9 kJ) and AW (CHO: 2.6+/-0.2 kJ; P: 2.4+/-0.2 kJ). There were no differences (p<0.05) between treatments for PT of the hamstrings (CHO: 91.6+/-6.5 Nm; P: 87.4+/-8.5 Nm) and quadriceps (CHO: 129.7+/-9.5 Nm; P: 123.0+/-10.6 Nm). The AT of the hamstrings (CHO: 77.8+/-5.2 Nm; P: 75.7+/-8.7 Nm) and quadriceps (CHO: 116.9+/-8.9 Nm; P: 110.0+/-8.5 Nm) were not statistically different (p>0.05) between the treatments. PG was significantly higher at the POST blood draw in the CHO treatment. No significant differences (p>0.05) were observed between the treatments for FFA and La concentrations. CONCLUSIONS: The data from this investigation indicate that the use of CHO supplementation during isokinetic leg exercise allows for the performance of more work.

Expanded role of nursing in ambulatory managed care. Part II: Impact on outcomes of costs, quality, provider and patient satisfaction.

This evaluation project used a triangulation of methods and data sources to link the expanded role nurse clinician (NC) to outcomes of costs, quality, and satisfaction in managed care. Results of patient surveys, case studies, cost-benefit analyses, interviews, focus groups, and HMO documents suggest that the impact of the role has benefit far beyond its costs. This article builds on an earlier article (Nursing Economic$, Vol. 17, No. 1). Part I reviewed literature on expanded role nursing in population management, and described the development of the NC role. In Part II, the NC expanded role is linked to organizational outcomes of costs, quality, and satisfaction. Results here could be used by managers and planners to provide rationale for implementing expanded nursing roles in managed care in order to improve ambulatory care processes, recruit and retain nurses, reduce costs, and increase patient and provider satisfaction.

Expanded role of nursing in ambulatory managed care. Part I: Literature, role development, and justification.

New expanded roles in nursing are developing in response to the health system switch from private, episodic care of individuals to health maintenance organizations (HMO's) focusing on disease prevention and promotion of health for populations of persons with chronic illness. This evaluation project explored the role of the nurse clinician in population and case management at a large HMO in the Northwest United States. In Part I of this two-part series, a literature review, is presented on chronic illness, ambulatory nursing, expanded role nursing, and nursing in HMOs. The development of the expanded role nurse clinician at the managed care organization is also described. Results could be used by HMOs to attract and retain nurses, improve care processes, and decrease costs in ambulatory care.

Inhibition of NO synthesis or endothelium removal reveals a vasoconstrictor effect of insulin on isolated arterioles.

In this study we tested the hypothesis that insulin may differentially affect isolated arterioles from red (RGM) and white gastrocnemius muscles (WGM) because of their differences in function and metabolic profile. We also determined whether the responses of these arterioles are endothelium dependent and mediated by either prostaglandins or nitric oxide (NO). Arterioles were isolated, pressurized to 85 mmHg, equilibrated in Krebs bicarbonate-buffered solution (pH 7.4) gassed with 10% O2 (5% CO2-85% N2), and studied in a no-flow state. Control diameters for first-order arterioles from RGM averaged 77 +/- 8 micrometers and from WGM averaged 77 +/- 5 micrometers. Cumulative dose-response curves to insulin (10 microU/ml, 100 microU/ml, 1 mU/ml, and 10 mU/ml) were obtained in arterioles before and after endothelium removal or administration of either indomethacin (Indo, 10(-5) M) or NG-nitro-L-arginine (L-NNA, 10(-4) M). Insulin evoked concentration-dependent increases in control diameter of intact RGM and WGM arterioles of 6-26% and 9-28%, respectively. Indo was without any effect on insulin-induced dilation in RGM and WGM arterioles. Insulin-evoked dilation in both RGM and WGM arterioles was completely inhibited and converted to vasoconstriction by endothelium removal and administration of L-NNA. These results indicate that in endothelium-intact arterioles from RGM and WGM, insulin evokes an endothelium-dependent dilation that is equivalent and mediated by NO. In contrast, in the absence of a functional endothelium, insulin evokes arteriolar constriction. The finding that insulin can constrict arterioles, at physiological concentrations, suggests that insulin may play a more significant role in the regulation of vascular tone and total peripheral resistance than previously appreciated.

Bridging the gulf between science and action: the "new fuzzies" of neopragmatism.

Rather than a philosophy, pragmatism is a way of doing philosophy that has major implications for solving disputes involving nursing science, theory, and practice that may otherwise be interminable. Pragmatism weaves together theory and action so that one modifies the other continuously, but both maintain their mutual relevance. Pragmatism emphasizes pluralism and diversity, and depends on an ethical base for determination of what is reasonable. Recently repopularized by the philosopher Richard Rorty and others, pragmatic ideals seem inherent to nursing. We propose that a better understanding of the history and utility of pragmatism will enhance both clinically relevant nursing theory and theoretically relevant nursing practice.

Women's experience of bed rest in high-risk pregnancy.

OBJECTIVE: To explore women's experience of bed rest in high risk pregnancy. DESIGN: Naturalistic, qualitative. SAMPLE, SETTING: Twelve adult, pregnant women on prescribed bed rest of a minimum of 20 hours per day and for at least 3-weeks duration were interviewed in one Western state of the U.S.A. regarding their experiences. FINDINGS: Three major themes were perceptions of high risk pregnancy, perceptions of bed rest, and the experience of time and restricted movement. The women described a high level of physical, emotional, familial, and economic hardship resulting from the bed-rest experience. Having adequate income, health insurance, and a supportive relative to take over household responsibilities were dimensions of successful maintenance of bed rest in the women. CONCLUSIONS: The routine obstetric procedure of bed-rest should be reevaluated in light of its lack of demonstrated effectiveness and potential to seriously harm women and their families. CLINICAL IMPLICATIONS: Women should be fully informed about controversies surrounding the efficacy of bed rest in pregnancy and encouraged to participate in decisions when complications occur regarding the prescription of prolonged bed rest.

Preconditioning with ischemia or adenosine protects skeletal muscle from ischemic tissue reperfusion injury.

Prolonged tissue ischemia and subsequent reperfusion results in significant tissue injury due to the ischemic-reperfusion (IR) syndrome. Ischemic preconditioning (IPC) or adenosine (ADO) pretreatment are known to protect IR injury in cardiac muscle. Our aim was to determine whether IPC or ADO pretreatment attenuates and protects against ischemic tissue reperfusion injury in skeletal muscle. Rats were anesthetized and global hindlimb ischemia was induced by 60 min of suprarenal aortic clamping followed by 30 min of reperfusion period. The degree of skeletal muscle dysfunction was determined by decreases in maximum contractile force, and adenosine triphosphate (ATP) and creatine phosphate (CP) levels of extensor digitorum longus (EDL) muscle. The distal tendon of the EDL was attached to a force transducer for maximum isometric force measurement. Samples were taken from the EDL for measurement of ATP and CP levels. The following were protective protocols prior to the IR challenge: (1) four consecutive 5-min periods of ischemia separated by 5-min reperfusion periods (PC/I) or (2) i.v. adenosine infusion (350 microg/kg/min x 10 min, PC/A). Our data suggest that pretreatment with brief periods of ischemia or systemic ADO infusion attenuates ischemic tissue reperfusion injury in skeletal muscle. [Table: see text]

Movement and time: exertion and perceived duration.

This study examined differences in consciousness indexes (perceived duration of time) at different levels of physical exertion within the framework of Newman's model of health and with emphasis on Prigogine's theory of dissipative structures. The sample consisted of 100 volunteers participating in regular aerobic exercise. Instruments included 817E Monarch Stationary Bicycles, 1800 Dynamap Automatic Blood Pressure/Pulse Monitors, the production method of time estimation, and the Perceived Exertion Scale. Repeated measures ANOVA revealed significant differences in consciousness indexes during exertion (p less than .00001). Paired t-tests yielded significant differences between the resting consciousness index and consciousness indexes at preferred, increased, and decreased exertion levels (p = .000). Results indicate that the consciousness index decreased with physical exertion regardless of actual exertion level. In addition, changes in perceived exertion and in physiological parameters suggest a pattern of expanding consciousness that is consistent with the theoretical framework.

Consciousness as a dissipative structure: an extension of the Newman model.

Newman's model of health as the expansion of consciousness and Prigogine's theory of dissipative structures provide the framework for the development of a model of consciousness as a dissipative structure. Relationships among Type A behavior, temporal orientation, and death anxiety are examined and explicated within the human field pattern of consciousness as a dissipative structure. Type A behavior, future orientation, and death anxiety are proposed as manifestations of consciousness with the potential to evolve to higher levels in accordance with Prigogine's theory. Preliminary research findings related to the model and suggestions for future research are also presented.