Heavy-resistance training in older Scandinavian men and women: short-and long-term effects on arm and leg muscles Lexell J, Downham DY, Larsson Y, Bruhn E, Morsing B. Heavy-resistance training in older Scandinavian men and women: short-and long-term effects on arm and leg muscles.

WHAT'S KNOWN ON THIS SUBJECT: Pulse oximetry screening at 24 hours of age improves detection of critical congenital heart disease in asymptomatic newborns. WHAT THIS STUDY ADDS:This study describes an initial experience with pulse oximetry screening for critical congenital heart disease and provides a strategy for preparing for state implementation of recent federal newborn screening recommendations. abstract OBJECTIVE: To assess the level of preparedness and resources needed in Minnesota for the implementation of newborn screening for critical congenital heart diseases (CCHDs). METHODS:A cross sectional survey of all birth centers in Minnesota was performed to assess the capacity to deliver care essential for the CCHD screening program. Compliance with the screening algorithm, nursing workload, and cost were assessed by using a pilot program implemented in 6 normal newborn nurseries.RESULTS: Ninety-one of 99 eligible centers participated in the survey and 90 reported the ability to screen newborns in accordance with recommendations. Only 22 centers, with 63% of births, had access to echocardiography and routinely stocked prostaglandins for neonatal use. Our pilot study screened 7549 newborns with 6 failed screens and 1 CCHD diagnosis. Two of the failed screens were due to misinterpretation of the algorithm, 1 failed screen was not reported, and 4 failed screens were not recognized. Repeated screens were required for 115 newborns, with 29% of retesting due to misinterpretation of the algorithm. The mean nursing time required was 5.5 minutes, and the cost was $5.10 per screen. CONCLUSIONS:In Minnesota, two-thirds of newborns are born in centers with resources for initial diagnosis and management of CCHD. Implementation of a pilot screening program demonstrated minimal increase in nursing workload, but identified problems with interpretation of the algorithm and data reporting. This pilot project suggests the need for simplification of the algorithm, additional training of health care providers, and development of a centralized reporting mechanism. Pediatrics 2013;132:e587-e594

Introduction: The purpose of this study was to determine the cardiovascular consequences elicited by activation of the inspiratory muscle metaboreflex in heart failure patients with preserved ejection fraction (HFpEF) patients and controls. Methods: HFpEF patients (n=15; 69±10 yrs; 33±4 kg/m2) and controls (n=14; 70±8 yrs; 28±4 kg/m2) performed an inspiratory loading trial at 60% maximal inspiratory pressure (PIMAX) until task failure. Mean arterial pressure (MAP) was measured continuously. Near-infrared spectroscopy and bolus injections of indocyanine green dye were used to determine percent change in blood flow index (%ΔBFI) from baseline in the vastus lateralis and sternocleidomastoid during the final minute of inspiratory loading. Vascular resistance index (VRI) was calculated. Results: Time to task failure was shorter in HFpEF than controls (339±197 s vs. 626±403 s; p=0.02). Compared to controls, HFpEF patients had a greater increase from baseline in MAP (16±7 vs. 10±6 mmHg) and vastus lateralis VRI (76±45 vs. 32±19%) as well as greater decrease in vastus lateralis %ΔBFI (-32±14 vs. -17±9%) (all, p<0.05). Sternocleidomastoid %ΔBFI normalized to absolute inspiratory pressure was higher in HFpEF compared to controls (8.0±5.0 vs. 4.0±1.9 % per cmH2O·s; p=0.03). Conclusions: These data indicate that patients with HFpEF exhibit exaggerated cardiovascular responses with inspiratory muscle metaboreflex activation compared to controls.

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