Visions of a cure. Visualization, clinical trials, and controversies in cardiac therapeutics, 1968-1998

In the early 1970s physicians engaged in fierce debates over the most appropriate method of evaluating the efficacy of coronary artery bypass grafting (CABG). With millions of patients and billions of dollars at stake, CABG sparked fierce controversy. Skeptics demanded that randomized controlled trials (RCTs) be performed, while enthusiasts argued that they already had visual proof of CABG's efficacy. When RCTs appeared, they did not settle the controversy. Participants simply reasserted their preconceptions, defending a trial's strengths or exploiting its flaws. The debate centered on standards of knowledge for the evaluation of therapeutic efficacy. Specifically, cardiologists and cardiac surgeons struggled to assess the relevance of different measures of therapeutic success: physiological or clinical, visual or statistical. Many factors contributed to participants' decisions, including disciplinary affiliation, traditions of research, personal experience with angiography, and assessments of the history of cardiac therapeutics. Physicians had to decide whether angiography provided a meaningful representation of the disease and its treatment or whether demonstrations of therapeutic success could come only from long-term statistical evaluation of mortality data.     

The initiation of distance learning at Thomas Jefferson University: the library as integral partner

In 1998 Thomas Jefferson University offered its first entirely online course. Librarians and library staff were integral in the development, support, evaluation, and refinement of this course. While staff members may have taken non-traditional roles in this effort, their roles generally fell within the broad guidelines of assisting University faculty with information and knowledge management. The development and support of distance course offerings will continue to be a focus at Scott Memorial Library.     

PubMed, Internet Grateful Med, and Ovid: a comparison of three MEDLINE Internet interfaces

Three MEDLINE Internet interfaces are compared: PubMed, Internet Grateful Med, and Ovid MEDLINE. Although these interfaces all search MEDLINE, significant differences exist in terms of their search interfaces, presentation of results, and special features. This paper examines these variations and explores some of the advantages and disadvantages of the three interfaces.     

Student activity levels, lesson context, and teacher behavior during middle school physical education

There is little research on students' engagement in physical activity in middle school physical education (PE). We observed student activity, lesson context, and teacher behavior in 430 PE lessons taught by 126 teachers in 24 schools. Variables were analyzed by mixed-model nested analyses of covariance. Boys were more active than girls overall and during skill drills, game play, and free play. Student activity varied by lesson context, with fitness activities producing the most activity. Class size was negatively associated with student activity. Daily PE contributed a weekly total of 25 min of vigorous activity and 83 min of moderate-to-vigorous activity--much less than national objectives. Results suggest that numerous opportunities exist for increasing student physical activity during middle school PE.     

From novice to no know-how: a longitudinal study of implicit motor learning

The aim of this study was to ascertain whether the performances of implicit and explicit learners would converge over an extended period of learning. Participants practised a complex motor skill--golf putting--for 3000 trials, either with a concurrent secondary, tone-counting task (implicit learning) or without such a task (explicit learning). The cognitive demands of the secondary task were predicted to prevent the accumulation of verbalizable rules about the motor task. The implicit group reported significantly fewer rules than the explicit group on subsequent verbal protocols. The performance of the implicit group remained below that of the explicit group throughout the learning phase. However, no significant differences were found between groups during a delayed retention test. Additionally, for the participants in the explicit group only, a Reinvestment Scale score correlated positively with the number of rules accrued and negatively with overall putting performance during the learning phase. We use the results to argue against the excessive use of verbal instruction during skill acquisition, which might be unnecessary and ultimately might hamper performance under stressful conditions.     

The effects of substrate and fluid provision on thermoregulatory and metabolic responses to prolonged exercise in a hot environment

A high ambient temperature reduces the capacity to perform prolonged exercise. Total carbohydrate oxidation is less, and thus glycogen depletion is not limiting. Fluid ingestion in the heat should, therefore, focus on maintenance of hydration status rather than on substrate provision. Six healthy males cycled to exhaustion at 60% of maximum oxygen consumption (VO2max) with no drink, ingestion of a 15% carbohydrate-electrolyte drink (1.45+/-0.29 litres) or ingestion of a 2% carbohydrate-electrolyte drink (3.12+/-0.47 litres). The ambient temperature was 30.2+/-0.6 degrees C (mean +/- s), with a relative humidity of 71+/-1% and an air speed of approximately 0.7 m x s(-1) on all trials. Weighted mean skin temperature, rectal temperature and heart rate were recorded and venous samples drawn for determination of plasma volume changes, blood metabolites, serum electrolytes and osmolality. Expired gas was collected to estimate rates of fuel oxidation. Exercise capacity was significantly (P < 0.05) different in all trials. The median (range) time to exhaustion was 70.9 min (39.4-97.4 min) in the no-drink trial, 84.0 min (62.7-145 min) in the 15% carbohydrate trial and 118 min (82.6-168 min) in the 2% carbohydrate trial. The 15% carbohydrate drink resulted in significantly (P < 0.05) elevated blood glucose and total carbohydrate oxidation compared with the no-drink trial. The 2% carbohydrate drink restored plasma volume to pre-exercise values by the end of exercise. No differences were observed in other thermoregulatory or cardiorespiratory responses between trials. These results suggest that fluid replacement with a large volume of a dilute carbohydrate drink is beneficial during exercise in the heat, but the precise mechanisms for the improved exercise capacity are unclear.     

Resilience of anthropometric data assembly strategies to imposed error

The aim of this study was to examine strategies for selecting a criterion value during anthropometric data assembly and their resilience to imposed error. Sixty-seven women aged 16-60 years were subjected to three separate series of measurements, which included six skinfolds and three girths. A random error term was added to the first of the three series of measurements to produce a pseudo-series containing error, termed the 'erroneous replicated series'. Five strategies were then used to determine the criterion value of each of the replication series: the first measurement, the mean of the first two measurements, the mean of all three measurements, the mean of the closest two measurements and the median of the three measurements. The technical error between the criterion values of the true and the flawed replication series for each of the selection strategies was calculated. We found that, for five of the skinfolds and all of the girths, the median value provided the smallest technical error of measurement between the criterion values for the true and erroneous replication series. We conclude that the strategy of selecting the median of three measurements is the most resilient to imposed error.