Learning from patients.
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Biomedical subjects
Publications and source records attributed to R Clifton.
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The purpose of this study was to quantify daily intra-individual variability in mean step length, a basic descriptor for the running pattern. Following 60 minutes of treadmill accommodation, nine trained male subjects (X age = 34.2 yrs +/- 7.2, X VO2max = 57.0 +/- 4.8 ml.kg-1.min-1) performed daily (Mon-Fri) 6-minute treadmill runs at three submaximal speeds (2.68, 3.13 and 3.58 m.s-1) over a 4-week period. To minimize extraneous influences, subjects refrained from road racing and completed the 20 running sessions (5 d.wk-1.4 weeks for each speed) at the same time of day and in the same footwear. Treadmill velocity was calibrated for each 6-minute running bout and step length was determined during the last 2 minutes of each run. Results indicated that mean step length and coefficient of variation values were 0.984 m and 2.50% at 2.68 m.s-1, 1.124 m and 2.22% at 3.13 m.s-1, and 1.254 m and 2.26% at 3.58 m.s-1. Reliability analyses indicated that the percentage of variation accounted for in step length across all speeds was high and improved very little as test number increased (range = 96% for two days vs 99% for five days). Taken together, these findings suggest that when testing conditions are controlled, within-subject variability in step length measures obtained at multiple submaximal running speeds is small in trained subjects and that criterion step length values can be obtained by averaging duplicate measurements.
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To assess whether distance runners displaying uneconomical freely chosen step lengths (FCSL) could be trained to shift FCSL toward a more optimal setting, six males and three females who exhibited uneconomical FCSL [mean optimal step length (OSL) = -9.81% of leg length from FCSL; mean change in oxygen uptake (VO2) (FCSL - OSL) = 1.46 ml.kg-1.min-1] comprised an experimental group that completed 15 treadmill sessions (30 min/day, 5 days/wk, 3 wk) of OSL training at individually determined running velocities (2.87-3.74 m/s). Training sessions featured alternating 5-min periods of combined audio and visual feedback matching OSL and no feedback. A control group of three subjects with uneconomical FCSL (2 males, 1 female) performed 3 wk of treadmill running without feedback. The extent of step length optimization was evaluated by comparing pre- and posttraining differences between FCSL and OSL and between pre- and posttraining VO2. Compared with the control group, the experimental group demonstrated a significantly (P < or = 0.05) greater relative shift in FCSL toward OSL and a marked reduction in FCSL VO2. Taken together, these results suggest that short-term audiovisual feedback training can be effective in optimizing step length and producing a decrease in aerobic demand among distance runners exhibiting uneconomical FCSL.
The health care revolution of the 1960s was affected not only by changes in government's public policy but also changes in Church teaching. As Medicare and Medicaid helped finance the building of many new facilities, religious institutes--influenced by the decisions of the second Vatican Council--began to redefine themselves. The growth in each area was a hopeful sign of the ability to care for more people and extend Jesus' healing mission. Today health care organizations face pressures to compete, diversify, and reorganize. To ensure that they remain renewed and vital in the midst of change, they must promote their mission and philosophy through reeducation and socialization. The chief executive officer, who ultimately is responsible for ensuring that the organization is value-driven, must not abdicate this responsibility. Maintaining a religious organization's mission is as essential to its survival as meeting the budget, developing a strategic plan, or recruiting physicians.
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Increasing numbers of medical students and their rising expectations for services have often burdened the facilities of offices of student affairs. The successful utilization of professional counselors as well as personnel trained in financial aid and study skills counseling is discussed, as is a program which uses medical students as tutors and advisers of fellow students.
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Although consciousness of a religious institute's sponsorship or mission in the nineteenth and early twentieth centuries was secondary to the more important function of religious formation, the health care environment in recent years has demanded a closer attention to mission. Religious institutes have identified the need to further articulate statements of mission and philosophy and to develop mechanisms to evaluate their effectiveness in promoting the community's values. In response to this need, Bon Secours Health System, Columbia, MD, developed a standing committee, the mission committee, to oversee the mission activities of the entities within each of its local holding companies. Among its responsibilities are the periodic review of programs, the monitoring of social justice actions in which the local corporation may be involved, the recommendation of policy concerning ethical and medical-moral issues to the board of directors, and the identification of educational need in these areas. A special focus on the system's mission activity has been indigent care, an area that the mission committee both monitors and directs. As a governance structure, the mission committee complements rather than detracts from the chief executive officer's responsibility for mission. Since its creation in 1983, it has proved valuable not only in ensuring the system's mission effectiveness but also in integrating the operations and mission perspectives.
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