Lee Stoner

The Added Value of Study Abroad: Fostering a Global Citizenry.

Few studies have employed experimental designs adequate for documenting the value added of studying abroad; that is, learning outcomes above and beyond that which may be achieved in domestic or traditional campus-based courses. Using a pre-/posttest, two-by-two factor design of course location (study abroad vs. home campus) by course subject matter (sustainability vs. nonsustainability), we found significant highest order interactions for three dependent measures of global citizenry. Results suggest that it is the combination of location (abroad) and academic focus that yields the greatest increases in specified learning outcomes for study abroad. Implications for political agendas, academic initiatives, and research directions are discussed.

Inflammatory biomarkers for predicting cardiovascular disease.

The pathology of cardiovascular disease (CVD) is complex; multiple biological pathways have been implicated, including, but not limited to, inflammation and oxidative stress. Biomarkers of inflammation and oxidative stress may serve to help identify patients at risk for CVD, to monitor the efficacy of treatments, and to develop new pharmacological tools. However, due to the complexities of CVD pathogenesis there is no single biomarker available to estimate absolute risk of future cardiovascular events. Furthermore, not all biomarkers are equal; the functions of many biomarkers overlap, some offer better prognostic information than others, and some are better suited to identify/predict the pathogenesis of particular cardiovascular events. The identification of the most appropriate set of biomarkers can provide a detailed picture of the specific nature of the cardiovascular event. The following review provides an overview of existing and emerging inflammatory biomarkers, pro-inflammatory cytokines, anti-inflammatory cytokines, chemokines, oxidative stress biomarkers, and antioxidant biomarkers. The functions of each biomarker are discussed, and prognostic data are provided where available.

Assessments of Arterial Stiffness and Endothelial Function Using Pulse Wave Analysis

Conventionally, the assessments of endothelial function and arterial stiffness require different sets of equipment, making the inclusion of both tests impractical for clinical and epidemiological studies. Pulse wave analysis (PWA) provides useful information regarding the mechanical properties of the arterial tree and can also be used to assess endothelial function. PWA is a simple, valid, reliable, and inexpensive technique, offering great clinical and epidemiological potential. The current paper will outline how to measure arterial stiffness and endothelial function using this technique and include discussion of validity and reliability.

Electrically stimulated resistance training in SCI individuals increases muscle fatigue resistance but not femoral artery size or blood flow

Study design:Longitudinal.Objectives:The purpose of this study was to evaluate the effect of lower extremity resistance training on quadriceps fatigability, femoral artery diameter, and femoral artery blood flow.Setting:Academic Institution.Methods:Five male chronic spinal cord injury (SCI) individuals (American Spinal Injury Association (ASIA): A complete; C5–T10; 36±5 years old) completed 18 weeks of home-based neuromuscular electrical stimulation (NMES) resistance training. Subjects trained the quadriceps muscle group twice a week with four sets of 10 dynamic knee extensions against resistance while in a seated position. All measurements were made before training and after 8, 12, and 18 weeks of training. Ultrasound was used to measure femoral artery diameter and blood flow. Blood flow was measured before and after 5 and 10 min of distal cuff occlusion, and during a 4-min isometric electrical stimulation fatigue protocol.Results:Training resulted in significant increases in weight lifted and muscle mass, as well as a 60% reduction in muscle fatigue (P=0.001). However, femoral arterial diameter did not increase. The range was 0.44±0.03 to 0.46±0.05 cm over the four time points (P=0.70). Resting, reactive hyperemic, and exercise blood flow did not appear to change with training.Conclusion:NMES resistance training improved muscle size and fatigue despite an absence of response in the supplying vasculature. These results suggest that the decreases in arterial caliber and blood flow seen with SCI are not tightly linked to muscle mass and fatigue resistance. In addition, muscle fatigue in SCI patients can be improved without increases in arterial diameter or blood flow capacity.Sponsorship:Grants HL65179, HD39676, and HD39676S2.

Upper vs Lower Extremity Arterial Function After Spinal Cord Injury

Abstract Background/Objective: The purpose of the study was to determine whether arterial diameter, flow- mediated dilatation (FMD), and arterial range are affected by spinal cord injury (SCI). We assessed arm (radial) and leg (posterior-tibial) arteries that are comparable in size and function to determine whether (a) arterial function is reduced in individuals with SCI vs nondisabled subjects and (b) decrements to SCI arterial function are greater in the legs vs arms. Participants: Eighteen men with chronic (9.8 ± 6.3 years) SCI (T2 to Til; American Spinal Injury Association A) and 13 nondisabled subjects matched for age (33.1 ± 4.8 vs 29.8 ± 8.2 years old, respectively), height, and weight (BMI = 25.3 ± 5.8 vs 26.6 ± 5.5 kg/m2, respectively). Methods: Radial and posterior tibial artery B-mode ultrasound images were continuously captured to measure resting diameter, occluded diameter, and postischemic diameters. Hierarchical linear modeling accounted for the nested experimental design. Results: Individuals with SCI have lower systemic (arm + leg) FMD than nondisabled subjects (9.3% vs 12.3%, respectively; P= 0.035), primarily because of reduced leg FMD (11.5 ± 3.1 % vs 7.0 ± 2.8% for SCI arms vs legs, respectively; P = 0.010). Persons with SCI also had lower arterial range than nondisabled subjects (0.79 vs 1.00 mm, respectively; P = 0.043), primarily because of the legs (0.81 ± 0.09 vs 0.56 ± 0.11 mm for SCI arms vs legs, respectively; P= 0.030). Conclusion: Leg arterial function seems to deteriorate at greater rates compared to the arms for individuals with SCI. Interventions to improve cardiovascular health should include measurements taken in the legs.

Electrical stimulation-evoked resistance exercise therapy improves arterial health after chronic spinal cord injury.

Study design:Repeated measures training intervention.Objectives:To evaluate the effects of neuromuscular electrical stimulation (NMES)-induced resistance exercise therapy on lower extremity arterial health in individuals with chronic, complete spinal cord injury (SCI). We define ‘arterial health’ using three surrogate markers: (a) resting diameter, (b) flow-mediated dilation (FMD), and (c) arterial range.Setting:Department of Kinesiology, University of Georgia, USA.Methods:We assessed five 36±5-year-old male individuals with chronic, complete SCI before, during, and after 18 weeks of training. The quadriceps femoris muscle group of both legs were trained twice a week with 4 × 10 repetitions of unilateral, dynamic knee extensions. The health of the posterior tibial artery was assessed using a B-mode ultrasound unit equipped with a high-resolution video capture device. Proximal occlusion was used to evoke ischemia for 5 min and then for 10 min. FMD was calculated using the peak diameter change (above rest) following 5 min occlusion. Arterial range was calculated using minimum (during occlusion) and maximum diameters (post 10 min occlusion). Hierarchical linear modeling accounted for the nested (repeated measures) experimental design.Results:FMD improved from 0.08±0.11 mm (2.7%) to 0.18±0.15 mm (6.6%) (P=0.004), and arterial range improved from 0.36±0.28 to 0.94±0.40 mm (P=0.001), after 18 weeks of training. Resting diameter did not significantly change.Conclusions:Home-based, self-administered NMES resistance exercise therapy consisting of 80 contractions/week improved FMD and arterial range. This provides evidence that resistance exercise therapy can improve arterial health after SCI, which may reduce the risk of future cardiovascular disease.

Did the American Medical Association make the correct decision classifying obesity as a disease

The American Medical Association (AMA) recently classified obesity a disease, defining obesity as having a Body Mass Index (BMI) measure above 30.1 This decision went against the advice of its own Public Health and Science Committee, and has sparked widespread discontent and discussion amongst medical and healthcare communities. The fact that this classification has been made has potential ramifications for health care around the world, and many factors need to be considered in deciding whether the decision to make obesity a disease is in fact appropriate.

Global Citizenship as a Learning Outcome of Educational Travel

Consistent with the Tourism Education Futures Initiative (TEFI) values, universities need to adequately prepare their graduates with the skills and knowledge needed in a global society. Correspondingly, U.S. universities have prioritized the development of study abroad to foster a global mindset. We offer that short-term, experiential educational travel programs provide a critical platform to foster global citizenship when coupled with sound pedagogy. Underpinned by a modified Value-Belief-Norm (VBN) framework, empirical evidence showcases global citizenship as a “value-added” learning outcome of educational travel. Moving forward, an updated model is needed to understand the juncture where students’ perspectives shift and new meanings are made.

Effects of Early Exercise Engagement on Vascular Risk in Patients with Transient Ischemic Attack and Nondisabling Stroke

The objective of this study was to conduct a randomized, parallel-group clinical trial assessed the efficacy of a health-enhancing physical activity program (exercise and education) on vascular risk factors and aerobic fitness in patients who have experienced a transient ischemic attack (TIA) or nondisabling stroke. Sixty patients (69±11 years) completed a baseline (BL) vascular risk stratification and aerobic fitness examination (cycle test) within 2 weeks of symptom onset. Subjects were then randomized to either an 8-week, twice weekly exercise program or to a usual-care control (CON) group. Postintervention (PI) assessments were completed immediately after the intervention and at 3-month follow-up. A series of primary (systolic blood pressure [SBP]) and secondary (vascular risk factors like total cholesterol [TC], high-density lipoproteins, etc.; Framingham risk score; peak oxygen uptake) outcome measures were assessed. Significantly greater reductions in SBP (mean change±SD; -10.4±9.2 mm Hg) and TC (-.53±.90 mmol/L) were observed between BL and PI assessments for the exercise group compared with the CON group (-1.9±15.4 mm Hg and -.08±.59 mmol/L, respectively) (P<.05). These improvements were maintained between the PI and the 3-month follow-up assessment (P>.05). Significant improvements in aerobic fitness were also observed and maintained at the 3-month follow-up assessment after regular exercise participation (P<.05). The early engagement in exercise resulted in significant improvements in vascular risk factors and fitness in those diagnosed with TIA. As these beneficial effects were maintained up to 3 months after completing the exercise program, exercise should be considered a useful additive treatment strategy for newly diagnosed TIA patients. Future research should examine the long-term efficacy of such programs.

OCCASIONAL CIGARETTE SMOKING CHRONICALLY AFFECTS ARTERIAL FUNCTION

Cigarette smoking is associated with impaired arterial function as measured by reduced vasodilation in response to reactive hyperemia. However, previous studies did not account for potential differences in shear stimuli. The purpose of this study was to use young, occasional smokers to ethically evaluate the effects of acute and chronic smoking on shear rate-diameter dose-response slopes. Young (20 to 26-y-old) nonsmokers (n = 9) and occasional (<1 pack/week) smokers were tested (n = 9). Smokers were tested after abstaining for 2 or more d and then immediately after smoking two cigarettes. Shear rate was manipulated using five upstream ischemic durations (0.5, 1, 2, 5 and 10 min). Radial artery blood velocities and diameters were assessed using Doppler ultrasound. Hierarchical linear modeling (HLM) was used to estimate change in diameter using repeated measures of shear rate nested within each subject. The shear rate-diameter slope was reduced by 35.9% in occasional smokers compared with nonsmoking controls (beta = 2.78(10-4) versus 1.78(10-4), p = 0.004). Acute smoking further attenuated the shear rate-diameter slope (i.e., arterial function) by 23.8% (beta = 1.79(10-4) versus 1.36(10-4), p = 0.037). These results suggest that repeated bouts of occasional cigarette smoking can chronically attenuate arterial function in otherwise healthy, young persons.