Wilson, Ted

Fetal alcohol spectrum disorder (FASD) is commonly misdiagnosed because of the complexity of presentation and multiple diagnostic criteria. FASD includes four categorical entities (fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol related neurodevelopmental disorder, and alcohol related birth defects). The four FASD diagnostic criteria are facial dysmorphology, growth deficiency, central nervous system dysfunction, and prenatal alcohol exposure. Sensory processing disorders (SPDs) are common in FASD and are observed as inappropriate behavioral responses to environmental stimuli. These can be either a sensory-based motor disorder, sensory discrimination disorder, or sensory modulation disorder. A child with SPD may experience challenges with their fine motor coordination, gross motor coordination, organizational challenges, or behavioral regulation impairments. FASD requires a multidimensional approach to intervention. Although FASD cannot be cured, symptoms can be managed with sleep-based therapies, sensory integration, and cognitive therapies. This paper reviews SPDs in FASD and the interventions that can be used by practitioners to help improve their therapeutic management, although it is unlikely that any single intervention will be the right choice for all patients.

Pulmonary function (PF) may be influenced by a deterioration of cardiac function. As such, resting measures of PF may be prognostically useful in heart failure patients (HF). This study examined the prognostic value of resting PF in a cohort of HF. This included 113 patients (enrolled 1999‐2005, EF=28±11%; age=55±12yr; 62% male) followed for 64±34mo with death confirmed via the SSI & Mayo Clinic registry. PF included, forced vital capacity, FVC; diffusing capacity, DLCO; forced expiratory volume, FEV1; alveolar volume, VA. Patients were divided in tertiles according to PF with survival analysis via Log‐rank Mantel‐Cox Test with Chi squared analysis (Chi‐sq). Groups for FVC: 1)=80, 2)81‐97, 3)=98, %pre (Chi‐sq 21.5, p<0.01). Bonferonni correction (BC) suggested differences (diff) between groups 1 & 2 and 1 & 3 (p=0.01) with no diff (ND) between 2 & 3 (p=0.62). Groups for FEV1: 1)=77, 2)78‐95, 3)=96, %pre (Chi‐sq 16.3, p<0.01). BC suggested diff between groups 1 & 2 (p=0.02) and 1 & 3 (p<0.01). Groups for DLCO: 1)=75, 2)76‐90, 3)=91, %pre (Chi‐sq=8.2, p=0.02). BC suggested diff between groups 1 & 3 (p=0.003) with ND between 1 & 2 or 2 & 3 (p>0.05). Groups for VA: 1)=87, 2)88‐97, 3)=98, %pre (Chi‐sq=8.9, p=0.01). BC suggested diff between 1 & 3 (p<0.01) with ND between 1 & 2 or 2 & 3 (p>0.05). In a well defined cohort of HF patients, resting measures of PF appear to be predictive of all cause mortality. NIH HL71478

Diabetics tend to have inadequate fruit consumption, elevated plasma glucose and insulin, and increased cardiovascular disease risk. Dried fruit may represent one way to increase fruit consumption among diabetics. Polydextrose is a commonly used soluble fiber and bulking agent providing very little available carbohydrate energy. The glycemic and insulinemic response of type 2 diabetics (n=13) to a single serving of white bread (57g; 160 Cal; 1 g fiber), raw cranberries (RC; 55g; 21 Cal; 1 g fiber), sweetened dried cranberries‐original (SCDO; 40g, 138 Cal; 2.1g fiber), and SDC‐less sugar (SDCLS; 40g; 113 Cal; 1.8g fiber + 10g polydextrose) was measured in a single cross‐over design. Plasma glucose (mg/dl) and insulin ( μU/ml) was measured prior to consumption, then 30, 60 and 120 minutes postprandially. Plasma glucose peaked at 30 or 60 min following bread, RC, SDCO, and SDCLS at 175 ± 10, 127 ± 7, 175 ± 10 and 158 ± 9 min, respectively, and remained significantly elevated 120 min following bread consumption. Peak plasma insulin for SDCO (15 ± 2) and RC (10 ± 1) was significantly less than bread (22 ± 2) or SDCO (22 ± 4), and remained slightly elevated at 120 minutes. The area under the curve values reflected similar changes. SDCLS consumption could be useful for improving fruit consumption by type 2 diabetics in a manner that provides glycemic and insulinemic benefits. Sponsor: Ocean Spray Cranberries Inc.

Acclimation to high altitude was characterized in nine non‐athletic college aged students aged 19 to 24 during a trek in the Himalayas. A three minute step test (40.6 cm step and a 24 step/minute rate) was performed at 1654 (am, day 1), 3696 (pm, day 1), 3865 (day 8), 3688 (day 10), 4115 (day 13) and again at 3688 meters (day 14). Resting heart rate and oxygen saturation (SaO 2 ) was measured prior to the step test and 20 seconds after exercise cessation (recovery). The heart rate difference (percent change) between pre‐ and post‐exercise cessation was used to measure hypoxic stress at altitude and significant acclimation could not be documented until day 14 (3688 m). The percent difference between pre‐ and post‐step test SaO 2 at 1654 m was significantly different from tests performed at 3696, 3865, 3688, and 4115 m. However, at day 14 (3688 m) the percent change in SaO 2 was no longer significantly different from the 1654 m value at day 1. Pre‐trip response to acute hypoxia (12.5 % O 2 ) was examined by performing the same step test at 402 m, with inconclusive results. This study suggests that 14 days are required for non‐athletic students to achieve acclimation to a step test.

Persons with metabolic syndrome could benefit from improved fruit consumption and reduced caloric intake. A cranberry fruit containing reduced titratable acidity was developed and used to create a 27% reduced calorie cranberry juice (RCCBJ) containing less added sugar (74 Cal/240 ml) relative to the 110 Cal/240 ml industry standard cranberry juice (CBJ). Subjects were recruited for metabolic syndrome (n=18; 53 16 years; BMI=34.4 ± 3.9) and their metabolic response to CBJ and RCCBJ was evaluated in single cross‐over fashion. Plasma glucose for CBJ at 0‐, 30‐, 60‐, and 120‐min was 105.6±12.3, 149.5±22.6, 127.9±30.3, and 98.6±14.6 (mg/dl). Plasma glucose for RCCBJ was 104.6±13.3, 140.3±22.5, 116.0±27.23, and 100.4±13. Plasma insulin for CBJ at 0‐, 30‐, 60‐, and 120‐ min was 10.21±5.1, 41.5±22.6, 30.3±19.7, and 12.0± (µIU/ml). Plasma insulin for RCCBJ was 12.2±8.4, 34.8±21.6, 20.7±13.9, and 12.3±9.8. For CBJ and RCCBJ plasma glucose and insulin significantly increased relative to baseline at 30‐ and 60‐min. At 60 min RCCBJ glucose and insulin were significantly less than CBJ. Plasma adiponectin and glucagon like peptide‐1 responses were also measured for CBJ and RCCBJ at 0‐, 30‐, 60‐, and 120‐min. Reduced acidity cranberry fruit was associated with RCCBJ containing 33% fewer calories and a beneficial metabolic response in persons with metabolic syndrome.

Mono‐and polyunsaturated fats in nuts, such as pistachios (PI), may improve lipoprotein and glycemic status. Overweight persons trend for dyslipidemia and high diabetes risk. The lower limits of PI consumption required for health benefits are unknown. This study determined if PI at bedtime promotes beneficial changes in metabolic status in overweight persons. Overweight subjects (n=22; 55 ± 2 yrs; 90 ± 3.6 kg; BMI 31 ± 1) were randomized to 35.4 g PI self‐administered at bedtime or control (CO; no PI) for 6 weeks. There was no difference in physical activity level between subjects receiving PI and CO. Body weight was not different in PI and CO at wk 0, 1, 2, 4, and 6. HDL cholesterol at wk 0 and 6 in PI was 49.2 ± 3.5 to 50.3 ± 3.0, and CO was 60.8 ± 3.8 and 58.0 ± 2.7 mg/dL, at wk 6 PI had improved slightly relative to CO (P= 0.12). Plasma glucose at wk 0 and 6 in PI was 104.6 ± 2.8 and 99.6 ± 2.6 mg/dL, and CO was 102.0 ± 2.8 and 101.1 ± 2.6 mg/dL, at wk 6 PI had improved slightly relative to CO (P= 0.16). Plasma insulin at wk 0 and 6 in PI was 8.5 ± 1.0 and 8.4 ± 0.9, and CO was 7.2 ± 0.7 to 8.8 ± 0.7 μU/mL, at wk 6 PI had improved slightly relative to CO (P = 0.21). Beneficial changes in HDL, glucose, and insulin probably requires slightly more than 35.4 g/d PI for 6 wks. To increase the probability of metabolic health benefits, nutritionists may wish to encourage levels of daily PI consumption higher than those administered in this study.

Pulse Decomposition Analysis (PDA) offers new insights into factors altering the arterial pressure pulse contour. PDA premise is that peripheral arterial pressure pulse envelope consists of distinct component pressure pulses, a left ventricular ejection and its reflections. Two PDA parameters appear to be particularly useful in quantifying the pulse contour. P2P1 is the ratio of second component pulse and primary ejection pulse amplitudes. T13 is the temporal delay between the third component pulse and the primary ejection pulse. P2P1 and T13 parameters were used to examine pressure pulse contour changes in 81 healthy subjects (18–27 yrs; BMI 27.5 ± 2.6) undergoing a Stroop mental stress test, cycle ergometer stress tests (3 min; 50W and 100W), and post‐exercise recovery. Digital pressure pulse contours were recorded/quantified using PDA formalism. Relative to baseline, P2P1 increased 8% post‐Stroop (individual variation 0% to 15%), T13 increased 4%, (individual variation 0% to 8%). Exercise decreased P2P1 21 ± 14%, while the T13 change was 19 ± 15%. PDA‐based pulse propagation model quantifies physical changes that arterial pulse reflection sites undergo. Peripheral arterial pressure pulse appears to be due to the primary ejection pulse and two major reflections. Two reflection sites in the central arteries appear to be responsible for the “reflected” wave part of the pulse contour.

Cold‐water swimming is a recreational activity that may become a future Winter Olympic event. However, unintentional cold‐water exposure can lead to hypothermia or death. Changes in body temperature are known to diminish swimming performance in persons experiencing hypothermia, although thermal changes during recreational exposure are not well characterized. This study examined skin temperature responses to a one‐kilometer swim in normal and cold‐water. Competitive swimmers (2 male and 2 female; age 44±17 years; BMI 24±2) completed a one‐kilometer swim (22 laps × 75 foot lengths) under free‐living indoor (25.5°C water and 25.0°C air) and cold outdoor (10.9°C water and 6.5°C) conditions. Skin temperature was determined with a digital infrared camera on the center of right palm, cubital fossa of arm, lateral aspect of pectoral muscle, cheek, and average of the four locations at 8.7±1.7 minutes before the swim (pre), then 0.6±0.2 and 6.4±2.1 minutes after the swim. Data (mean±SD) was analyzed with repeated measures ANOVA with significance if P<0.05. Swimmers completed the indoor and outdoor swim events in 20.7±1.7 and 21.8±1.1 minutes respectively. Average indoor skin temperature at −8.7, +0.6 and +6.4 minutes was 94.0±1.7, 85.3±1.9, and 88.1±2.2°C. Average outdoor skin temperature at −8.7, +0.6 and +6.4 minutes was 83.0±3.6, 53.5±2.3, and 67.7±2.0°C. At all times average outdoor skin temperature was lower than indoor, with the lowest temperature 0.6 minutes post‐swim. Palm indoor temperature at −8.7, +0.6 and +6.4 minutes was 91.6±3.9, 83.1±0.5, and 87.3±5.0°C. Palm outdoor temperature at −8.7, +0.6 and +6.4 minutes was 75.1±7.9, 47.4±2.7, and 58.1±2.7°C. At all times outdoor palm temperature was lower than indoor, with the lowest temperature 0.6 minutes post‐swim. Similar thermal responses were observed in the cheek, cubital fossa and pectoral locations. While time to complete the indoor and outdoor one km swims were similar, swimming in cold water was associated with delayed rewarming in the palm and cheek relative to cubital fossa and pectoral muscle.

Cold‐water swimming is a recreational activity that may become a future Winter Olympic event. However, unintentional cold‐water exposure can lead to arrhythmias, changes in electrocardiogram (ECG) appearance, and death. This study sought to characterize cardiac responses to recreational one‐kilometer swims performed in normal and cold‐water. Competitive swimmers (2 male 2 female; age 44±17 years; BMI 24±2) completed a one‐kilometer swim (22 laps × 75‐foot lengths) under free‐living indoor (25.5°C water and 25.0°C air) and cold outdoor (10.9°C water and 6.5°C) conditions. Continuous ECGs were obtained with a waterproof recording system (Actiwave, CamNtech Inc., Boerne, TX). ECG PR‐, QT‐, and RR‐intervals (sec), ventricular diastole (sec), and heart rate (beats/minute) were measured 8.7±1.7 minutes before the swim, then 0.6±0.2, 3.0±0.0 and 6.4±2.1 minutes after the swim. Data (mean±SD) was analyzed with repeated measures ANOVA with significance if P<0.05. Swimmers completed the indoor and outdoor swim events in 20.7±1.7 and 21.8±1.1 minutes, respectively. For the indoor swim, PR‐interval (sec) at −8.7, +0.6, +3, and +6.4 minutes was 0.12±0.01, 0.12±0.01, 0.11±0.01, and 0.12±0.01, and PR‐interval for the outdoor swim at −8.7, +0.6, +3.0 and +6.4 minutes was 0.13±0.01, 0.13±0.01, 0.13±0.01, and 0.14±0.01 (sec). PR‐interval was significantly longer at +6.4 minutes post cold‐water swim. For the indoor swim, ventricular diastole (sec) at −8.7, +0.6, +3, and +6.4 minutes was 0.37±0.06, 0.22±0.04, 0.30±0.01, and 0.32±0.05 (sec), and for the outdoor swim at −8.7, +0.6, +3.0 and +6.4 minutes ventricular diastole was 0.35±0.08, 0.19±0.02, 0.30±0.04, and 0.24±0.06 (sec). Ventricular diastole was significantly shorter at +6.4 minutes post cold‐water swim. No significant changes were observed for QT‐interval, RR‐interval, and heart rate between swim conditions. These parameters were also assessed for the ECG recordings collected during the 20.7±1.7‐minute normal and 21.8±1.1‐minute cold‐water swims to characterize the physiological response during swim exercise. This study of normal and cold‐water one‐kilometer recreational swimmers determined that a waterproof ECG could generate a continuous record of changes in cardiac function. During cold‐water swim recovery (+6.4 minutes) PR interval was lengthened and ventricular diastole was shortened suggesting an influence of temperature on cardiac function.

Assessments of electrocardiographic (ECG) responses during swimming activities are impossible without mobile waterproof recording units and rarely completed. This preliminary study characterized changes in the ventricular diastolic, PR‐, QT‐, and RR‐intervals that occurred during a 1 km indoor swim in 78°F water with a waterproof Actiwave ECG recording system (CamNtech Inc., Boerne, TX) and the .epf data files were analyzed with software from ADInstruments Inc. (Colorado Springs CO). Values within times expressed as mean ± SE with significance evaluated using ANOVA and repeated measures. Competitive club swimmers (3 male, 1 female) with an age, height, and weight of 51 ± 3 years, 175 ± 4 cm, and 83 ± 8 kg, with a BMI of 27 ± 2 completed the 1 km swim (44 laps × 75 foot laps) using a standard crawl in 17.9 ± 1.3 minutes using 10.5 ± 0.50 arm cycles/second. A continuous ECG with waveform was obtained and measurements were performed 120 and 30 seconds before swim, during the swim (at end of lap‐1, ‐22 and ‐43), and at 30 and 300 seconds post‐completion. Heart rate (from RR‐interval) −120, and −30 seconds prior to the swim, at end of swim lap 1, 22 and 43, and during recovery 30 and 300 seconds post swim was 68 ± 5, 73 ± 6, 107 ± 3, 142 ± 4, 147 ± 5, 132 ± 8 and 89 ± 3 beats/minute (P<0.0001). Respective QT‐intervals were 392 ± 14, 374 ± 13, 307 ± 38, 259 ± 15, 254 ± 2, 255 ± 14, and 338 ± 6 msec (n = 2 at lap‐1, and n = 3 at lap‐22) (P<0.0001). Respective ventricular diastole time was 509 ± 61, 468 ± 61, 253 ± 45, 166 ± 10, 166 ± 7, 204 ± 25 and 339 ± 26 msec (P<0.0001). Respective PR‐Intervals were 130 ± 12, 127 ± 12, 111 ± 18, 111 ± 2, 105 ± 14, 107 ± 15 and 125 ± 18 msec (P<0.094). Heart rate increased and duration of ventricular diastole decreased between lap 1 and 22, and was relatively stable between lap 22 and the end of lap 43. This study determined that with appropriate waterproof equipment a continuous ECG record can be collected from swimming athletes and used to provide an accurate assessment swim‐associated changes in cardiac function. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .