Carbohydrate supplementation delays DNA damage in elite runners during intensive microcycle training

The aim of this study was to evaluate the effect of carbohydrate supplementation on free plasma DNA and conventional markers of training and tissue damage in long-distance runners undergoing an overload training program. Twenty-four male runners were randomly assigned to two groups (CHO group and control group). The participants were submitted to an overload training program (days 1-8), followed by a high-intensity intermittent running protocol (10 x 800 m) on day 9. The runners received maltodextrin solution (CHO group) or zero energy placebo solution as the control equivalent before, during, and after this protocol. After 8 days of intensive training, baseline LDH levels remained constant in the CHO group (before: 449.1 +/- 18.2, after: 474.3 +/- 22.8 U/L) and increased in the control group (from 413.5 +/- 23.0 to 501.8 +/- 24.1 U/L, p < 0.05). On day 9, LDH concentrations were lower in the CHO group (509.2 +/- 23.1 U/L) than in the control group (643.3 +/- 32.9 U/L, p < 0.01) post-intermittent running. Carbohydrate ingestion attenuated the increase of free plasma DNA post-intermittent running (48,240.3 +/- 5,431.8 alleles/mL) when compared to the control group (73,751.8 +/- 11,546.6 alleles/mL, p < 0.01). Leukocyte counts were lower in the CHO group than in the control group post-intermittent running (9.1 +/- 0.1 vs. 12.2 +/- 0.7 cells/mu L; p < 0.01) and at 80 min of recovery (10.6 +/- 0.1 vs. 13.9 +/- 1.1 cells/mu L; p < 0.01). Cortisol levels were positively correlated with free plasma DNA, leukocytes, and LDH (all r > 0.4 and p < 0.001). The results showed that ingestion of a carbohydrate beverage resulted in less DNA damage and attenuated the acute post-exercise inflammation response, providing better recovery during intense training.

Weight and neuro-psycho-motor development in children discharged from neonatal intensive care unit

Background: Low birth weight affects child growth and development, requiring the intensive use of health services. There are conversely proportional associations between prematurity and academic performance around the world. In this study we evaluated factors involved in weight and neuropsychomotor profile in one and two years old discharged from Intensive Care Units (ICU). Methods/Design: We investigated 203 children from the ICU who were followed for 24 +/- 4 months. The research was conducted by collecting data from medical records of patients in a Follow-up program. We investigated the following variables: inadequate weight at one year old; inadequate weight at two years old and a severe neurological disorder at two years old. Results: We observed increase of almost 20% in the proportion of children which weighted between the 10th and 90th percentiles and decrease of around 40% of children below the 15th percentile, from one to two years old. In almost 60% of the cases neuropsychomotor development was normal at 2 years old, less than 15% of children presented abnormal development. Variables that remained influential for clinical outcome at 1 and 2 years old were related to birth weight and gestational age, except for hypoglycemia. Neurological examination was the most influential variable for severe neurological disturbance. Conclusion: Hypoglycemia was considered a new fact to explain inadequate weight. The results, new in Brazil and difficult in terms of comparison, could be used to identify risk factors and for a better approach of newborn discharged from ICUs.

Impact of a participatory program to reduce noise in a Neonatal Unit

This study evaluated the impact of a participatory program to reduce noise in a neonatal intermediate care unit of a university hospital. A time-series quasi-experimental design was used, in which sound pressure levels were measured before and after the intervention was implemented using the Quest-400 dosimeter. Non-parametric statistical tests were used to compare noise with the level of significance fixed at 5%. Results showed significant reduction of sound pressure levels in the neonatal unit after the intervention program was implemented (p<0.0001). The average Leq before the intervention was 62.5dBA and was reduced to 58.8dBA after the intervention. A reduction of 7.1dBA in the average Lmax(from 104.8 to 87.7dBA) and of 30.6dBA in the average Lpeak(from 138.1 to 107.5dBA) was observed. The program was proven to be effective in significantly reducing noise levels in the neonatal unit, although levels were still more intense than recommended.

Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus

To evaluate whether an interdisciplinary intervention program on lifestyle results in better quality of life (QoL) and lower frequencies of depression and binge eating disorder (BED) in individuals at risk for type 2 diabetes mellitus. A total of 177 individuals (32.2% men, age 55.4 +/- A 12.5 years) at risk for diabetes were allocated to a 9-month traditional (TI) or intensive interdisciplinary intervention (II) on dietary habits and physical activity including psychoeducative groups. They were submitted to questionnaires and clinical and laboratory examinations. Predictors of non-adherence were analyzed by logistic regression. Only individuals submitted to II had blood pressure and plasma glucose levels reduced. Frequencies of depression reduced in both interventions but of BED only in II (28.0-4.0%, P < 0.001). Increments in the scores of SF-36 domains (physical functioning: 11.1 +/- A 14.0 vs. 5.3 +/- A 13.0, role-emotional: 20.4 +/- A 40.2 vs. 6.2 +/- A 43.8, P = 0.05) were greater in the II than in TI, respectively. Changes in SF-36 correlated with decreases in anthropometry, blood pressure and glucose levels, depression and BED scores. Male gender was independently associated with non-adherence to the II. In addition to metabolic benefits, an interdisciplinary approach may induce desirable extrametabolic effects, favoring the control of psychiatric disorders and improving the QoL of individuals at risk for diabetes.

Postgraduate training program

BACKGROUND: Faculties face the permanent challenge to design training programs with well-balanced educational outcomes, and to offer various organised and individual learning opportunities. AIM: To apply our original model to a postgraduate training program in rheumatology in general, and to various learning experiences in particular, in order to analyse the balance between different educational objectives. METHODS: Learning times of various educational activities were reported by the junior staff as targeted learners. The suitability of different learning experiences to achieve cognitive, affective and psychomotor learning objectives was estimated. Learning points with respect to efficacy were calculated by multiplication of the estimated learning times by the perceived appropriateness of the educational strategies. RESULTS: Out of 780 hours of professional learning per year (17.7 hours/week), 37.7% of the time was spent under individual supervision of senior staff, 24.4% in organised structured learning, 22.6% in self-studies, and 15.3% in organised patient-oriented learning. The balance between the different types of learning objectives was appropriate for the overall program, but not for each particular learning experience. Acquisition of factual knowledge and problem solving was readily aimed for during organised teaching sessions of different formats, and by personal targeted reading. Attitudes, skills and competencies, as well as behavioural and performance changes were mostly learned during caring for patients under interactive supervision by experts. CONCLUSION: We encourage other faculties to apply this approach to any other curriculum of undergraduate education, postgraduate training or continuous professional development in order to foster the development of well-balanced learning experiences.

Management Intensive Grazing of Stockers at the Andrew Jackson Demonstration Farm (1996 – 1998)

The Andrew Jackson Demonstration Farm (AJDF) is located in central Jackson County in east central Iowa. A board of directors operates the farm for the purpose of demonstrating different production practices and management strategies. From 1996 to 1998 management intensive grazing practices and the grazing of stockers on a combination of permanent and tillable pasture have been demonstrated. Grazing strategies or practices demonstrated during these years included establishment of Eastern Gamagrass and Big Bluestem, variable density grazing, measuring forage on-offer, estimating dry matter intake, grazing corn, pasture renovation, and fencing and water systems. Production performance data were gathered for the three years stockers that were grazed. During this time the stockers averaged 121 animal days of grazing, a 1.1 head per acre stocking rate, a 1.85 pound average daily gain, and 228 pounds of gain per acre. The financial measures evaluated the value of gain on pasture and the pasture cost of the gain. The value of gain per pound was positive for 1996 and 1997 at $.58 and $.52 whereas in 1998 it was a -$.04. Pasture costs per pound of gain ranged from $.12 to $.16. Production performance is only one part of the profit picture when evaluating a stocker operation. Buysell margins are the other significant part that can greatly impact the profit potential of a summer grazing program.

Intensive Rotational Grazing of Steers on Highly Erodible Land at the Adams County CRP Project

Grazing yearling steers is one way to utilize the forages required for participation in the Conservation Reserve Program (CRP) after CRP contracts expire. In 1995, a stocker-steer intensive-rotational grazing study was conducted at the CRP Research and Demonstration Project near Corning, Iowa. A similar study was carried out in 1994. Seventy-five yearling crossbred steers grazed a 65- acre pasture that had been divided into 27 paddocks using electric fencing from May 4, 1995 to September 14, 1995. During this period, the 65-acre pasture system produced 9,975 animal-days of grazing and 11,403 pounds of gain. On a per-acre basis, this translates to 153.5 animal-days of grazing and 175.4 pounds of gain. The stocking rate was constant for the entire 133- day grazing season at 1.15 steers per acre. On May 4, 1995, the beginning of the grazing season, the average weight of the steers was 495.7 pounds. By the end of the grazing trial on September 14, 1995, the average weight of the steers had increased to 647.7 pounds. The average gain per steer during the 133-day grazing period was 152 pounds, and the average daily gain per steer was 1.14 pounds. The average bodyweight of the steers during the entire grazing season was 571.7 pounds.

Rotation Grazing Demonstrations With Beef Cows on HEL - Adams County Conservation Reserve Program (CRP) Project

Two grazing systems were demonstrated on Conservation Reserve Program (CRP) land in southwestern Iowa near Corning in the summers of 1991, 1992, 1993, 1994, and 1995. This report summarizes the 1995 data and compares them to results from the four previous years. The systems, a 13-paddock intensive-rotational grazing system and a 4-paddock more traditional rotation, both established in 1991, are aimed at showing economically sustainable grass alternatives for steeply sloping (9-14% slope), highly erodible land (HEL) once the 10-year CRP ends. In a 147-day grazing season in 1995, nursing crossbred calves with no creep gained 2.36 pounds and 2.38 pounds per day on the 13- and 4-paddock systems, respectively. The rotations were stocked at 1.65 acres per cow-calf pair on the 13-paddock system and 1.72 acres per pair on the 4-paddock system. This produced 210.2 pounds of calf gain per acre on the 13-paddock system and 203.2 pounds of calf gain per acre on the 4- paddock system.. Similar calves gained 2.37 pounds and 2.50 pounds per day for 155 days, yielding a total gain per acre of 222.7 pounds on the 13-paddock system and 224.9 pounds on the 4-paddock system in 1994. Results for 1992 remain the highest from both systems in the five years of grazing, with calf gain per head per day at 2.45 for 155 days netting 241.9 pounds per acre on the 13- paddock system and calf gain per head per day at 2.38 for 154 days on the 4-paddock system yielding 263.6 pounds per acre. Cows maintained both their weight and condition scores in both systems again in 1995. A third system, the 18-paddock intensive-rotational grazing system, was stocked with stocker steers in 1995, and the results are reported in a second article in the 1996 ISU Beef Research Report entitled “Intensive- Rotational Grazing Steers on Highly Erodible Land at the Adams County CRP Project.” Concerning grazing management, paddocks were grazed four, five, or six times in the 13-paddock intensive- rotational grazing system during the 147-day grazing season of 1995. This number of times grazed per paddock was nearly equal to times grazed per paddock in 1994. However, several paddocks were subdivided temporarily to equalize paddock size and increase grazing uniformity. This increased the total number of cattle moves in the 13-paddock system from 78 in 1994 to 109 in 1995. The average length of stay on each paddock or subdivision of a paddock per grazing time was 1 to 2.2 days. This was less than in any of the other four grazing years in this project. The principle of not grazing more than half the standing forage during any one grazing period was closely followed in 1995. All paddocks in the 13-paddock system were also rested approximately the recommended 30 days between each grazing cycle in 1995.

Idiographic Self-Monitoring Instruments to Empower Client Participation and Evaluate Outcome in Intensive Family Preservation Services

Intensive Family Preservation Services seek to reflect the values of focusing on client strengths and viewing clients as colleagues. To promote those values, Intensive Family Preservation Programs should include a systematic form of client self monitoring in their packages of outcome measures. This paper presents a model of idiographic self-monitoring used in time series, single system research design developed for Family Partners, a family preservation program of the School for Contemporary Education in Annandale, Virginia. The evaluation model provides a means of empowering client families to utilize their strengths and promote their status as colleague in determining their own goals, participating in the change process, and measuring their own progress.

Intensive Family Preservation Services: Do They Have Any Impact on Family Functioning?

Tills article presents a review of the intensive family preservation evaluation literature, the prepost test rnethology employed to evaluate three models in one state and the findings which have informed policymakers and program designers as the service expands. After intensive family preservation services, significant changes were found in parent-centered risk, parental disposition, and child-centered and child performance. No changes were found in economic risk and household adequacy.

Intensive Family Reunification Services: A Conceptual Framework and Case Example

Recent federal mandates require child welfare agencies to make reasonable efforts to reunify families after out-of-home placement. Consistent with those mandates, agencies are increasingly employing techniques from family preservation services intended initially to prevent out-of-home placement. The purpose of this article is to articulate a conceptual framework and practice guidelines for family reunification services and to describe an experimental reunification program based on a family preservation model. A case example illustrates the way in which the services affected one family that participated in the experiment.

Intensive Family Preservation Services: A Short History but a Long Past

Intensive family preservation services (IFPS) is a program model that has been disseminated widely throughout the country, and has received federal recognition and monetary support since the early 1980s. Recently, IFPS has been criticized for seemingly being unable to prevent out-of-home placements. The authors contend that many evaluators and policy analysts have lost sight of the historical roots of IFPS, and are focusing only on recent fiscal and policy contexts when assessing IFPS program effectiveness. This article reviews the therapeutic and programmatic origins of IFPS including desired treatment outcomes, and suggests that evaluators and policy analysts redirect their focus accordingly.

Intensive Family Preservation in Children's Mental Health: Predictors of Placement

This article examines the predictors of placement following IFPSfor a sample of child mental health service recipients and their families. Risk and protective factors vary depending on the time frame under consideration. Immediately following service, children 's level of Social/Legal functioning, a previous group home placement, and the presence of mental health problems for other family members increase risk of placement, while the number of follow-up services serves to lessen risk. Three to six months after service, the presence of a child behavior presenting problem and a projected placement in foster care serve as protective factors, while two service targets, alcohol monitoring and time management, serve to increase risk. Appropriate use of results for program design and for structuring access to services is discussed.

Training in intensive care medicine. A challenge within reach.

The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. Training based on competences guarantees more transparent, updated and homogeneous learning of objective quality, and which can be homologated internationally. The tutors play a key role as the main directors of the process, and institutional commitment to their work is crucial. In this context, tutors should receive time and specific formation to allow the evaluation of training as the cornerstone of the new model. New forms of objective summative and training evaluation should be introduced to guarantee that the predefined competences and skills are effectively acquired. The free movement of specialists within Europe is very desirable and implies that training quality must be high and amenable to homologation among the different countries. The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities.

Models for intensive care training. A European perspective.

The diversity of European culture is reflected in its healthcare training programs. In intensive care medicine (ICM), the differences in national training programs were so marked that it was unlikely that they could produce specialists of equivalent skills. The Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) program was established in 2003 as a Europe-based worldwide collaboration of national training organizations to create core competencies for ICM using consensus methodologies to establish common ground. The group's professional and research ethos created a social identity that facilitated change. The program was easily adaptable to different training structures and incorporated the voice of patients and relatives. The CoBaTrICE program has now been adopted by 15 European countries, with another 12 countries planning to adopt the training program, and is currently available in nine languages, including English. ICM is now recognized as a primary specialty in Spain, Switzerland, and the UK. There are still wide variations in structures and processes of training in ICM across Europe, although there has been agreement on a set of common program standards. The combination of a common "product specification" for an intensivist, combined with persisting variation in the educational context in which competencies are delivered, provides a rich source of research inquiry. Pedagogic research in ICM could usefully focus on the interplay between educational interventions, healthcare systems and delivery, and patient outcomes, such as including whether competency-based program are associated with lower error rates, whether communication skills training is associated with greater patient and family satisfaction, how multisource feedback might best be used to improve reflective learning and teamworking, or whether increasing the proportion of specialists trained in acute care in the hospital at weekends results in better patient outcomes.