There are no long-term, longitudinal, multi-site studies of stress and coping after heart transplantation (HT). The purposes of this study were to describe patterns of stress and coping over time, identify differences in coping use at 5 and 10 years after HT by demographic variables, and identify predictors of overall stress at 5 and 10 years after HT.

The aim of this study was to explore the effects of barbiturate coma on cerebral tissue oxygen tension and cerebrovascular pressure reactivity (PRx), as an index of cerebral autoregulation in severe head injury patients. This was a prospective observational clinical study of 12 patients with severe traumatic brain injury, carried out at a tertiary-level neurosurgical intensive care unit between April 2002 and May 2005. All patients received standard neurosurgical intensive care and monitoring. Probes for intracranial pressure (ICP), brain temperature (BT) and brain tissue oxygenation (PTiO2) were inserted into (noncontused) normal-looking white matter. Cerebrovascular PRx was measured as a moving correlation between ICP and arterial blood pressure. Barbiturate coma was instituted when ICP became refractory (ICP>20 mmHg). All data from the multimodal monitoring were digitally extracted and statistically analysed. The mean ICP decreased with barbiturate coma in eight of the 12 patients (75% of the patients), but only four achieved a value below 20 mmHg. Of eight patients with prebarbiturate PTiO2 levels above 10 mmHg, six had a further improvement in oxygenation. Thus, concordant favourable changes in ICP, PRx and PTiO2 with barbiturate coma were seen in those who survived. Effective response to barbiturates can be detected by improved PTiO2 and autoregulation (PRx) in severe head injury patients.

Analysis of slow waves in arterial blood pressure (ABP) and intracranial pressure (ICP) has been used as an index to describe cerebrovascular pressure-reactivity. It has been previously demonstrated that the pressure-reactivity index (PRx) can be used to reflect global cerebrovascular reactivity with changes in ABP. A positive PRx signifies a positive association between ABP and ICP, indicating a non-reactive vascular bed, while a negative PRx is reflective of intact cerebral autoregulation, where ABP waves provoke inversely correlated waves in ICP. To date, there has been no characterization of pressure-reactivity following decompressive craniectomy. In this prospective observational study, 33 patients who underwent surgery for acute brain injury with mass lesions for which the bone flap was left out were studied. The PRx was calculated as a moving correlation coefficient between 30 consecutive samples of values of ICP and ABP averaged for a period of 10 s. The time profiles of mean PRx values at 6-hourly intervals were analysed and compared with that in seven patients treated by medical therapy alone. The initial mean PRx 6 h after surgery was positive, indicative of disturbed pressure-reactivity. With time, PRx trended towards a more negative value, suggestive of an improving cerebrovascular autoregulatory reserve. The mean PRx 24 h after surgery was 0.28 (+/- 0.26), while the mean PRx 72 h after surgery was 0.15 (+/- 0.25) ( p = 0.012). In contrast, the mean PRx in patients that were not decompressed did not change significantly with time ( p = 0.357). Surgery in acute brain injury for which the bone flap is left out in anticipation of raised intracranial pressure in the postoperative period leads to an improved PRx as compared with controls. Craniectomy in this situation may have a contribution to the restoration of disturbed cerebrovascular pressure-reactivity.

1114 Because of the high level of functional limitation and cardiovascular risk among persons with stroke, it is important to identify optimal 'doses' of exercise based on evidenced-based outcomes that delineate the safety of the activity and the specific health outcomes achieved by various exercise regimens for this population. However, though there is extensive research supporting the positive relationship between physical activity and various health benefits, evidence indicates that various lifestyle and health-related factors may influence the dose-response relationship between physical activity and aerobic capacity. PURPOSE: To identify factors that predict optimal response to aerobic exercise among stroke survivors. METHODS: Twenty- five subjects aged 24 to 76 years with unilateral stroke (post stroke > 6 months) and residual weakness and/or spasticity of the affected lower extremity were assigned to one of three experimental conditions: (a) a 14-week intensity-oriented exercise program designed to increase participants' intensity of exercise while keeping exercise duration constant, (b) a 14-week duration-oriented exercise program designed to increase length of exercise time while keeping exercise intensity constant, and (c) a “standard of care” group that participates in a traditional stroke rehabilitation program consisting of gait training, balance and range of motion exercises. Participants were assessed on aerobic capacity and economy at baseline and at post-intervention (14 weeks). RESULTS: The baseline peak VO2 was significantly correlated with the percent gain in pre-post peak VO2 (r = −.87). The negative correlation suggests that the improvement in peak VO2 is greatest in stroke survivors who had the lowest pre-peak VO2 value. There was also a significant negative correlation (r = −.48) between baseline body weight and percent gain in economy (submaximal oxygen cost at a workload of 40 W), which suggests that the gain in economy is more difficult to attain for subjects who had more body weight. CONCLUSION: Stroke subjects with severely deficient baseline aerobic capacity and lower body weight may achieve gains in peak VO2 and economy even from minimal doses of physical activity.

PURPOSE To evaluate the degree of accessibility of fitness centers for people with disabilities. METHODS 59 fitness facilities in urban and suburban areas across the United States were selected to participate in a national study in order to assess the accessibility of fitness environments for people with disabilities. 50 subjects consisted of 34 consumers with various type of mobility related disabilities and 26 fitness professionals were asked to visit multiple fitness facilities within their regions to evaluate the degree of accessibility for several fitness environments using the AIMFREE (Accessibility Instruments Measuring Fitness and Recreation Environments) instrument. RESULTS Of the 20 identified fitness environments, staff attitudes, staff behavior, information, hot tubs, saunas, and swimming pools were rated as least accessible by consumers, while professionals graded telephones, access routes, hot tubs, saunas, and swimming pools with the lowest accessibility scores. Elevators, bathrooms, water fountains and parking lots were rated as most accessible by both groups. There was no apparent accessibility difference between fitness facilities in urban and suburban areas reported by consumers except for information accessibility (p < .01). However, the professionals did report significant differences in the accessiblity of hot tubs (p < .01), saunas (p < .05), equipment (p < .05), and telephones (p < .05) in urban and suburban fitness facilities. CONCLUSION While the general areas of the facility, including parking lots, elevators, water fountains, and bathrooms were found to be accessible, staff attitudes and behaviors, hot tubs, saunas, and swimming pools remain major environmental obstacles for people with disabilities to participate in fitness activities in the United States.

This paper describes assay procedures for territrems A, B, and C by thin layer chromatography (TLC)-fluorodensitometry and reverse phase high performance liquid chromatography (HPLC).