Patients with severe chronic obstructive pulmonary disease (COPD) have a greater neural drive to the parasternal intercostal and scalene muscles and greater inspiratory expansion of the rib cage than do healthy individuals. However, such patients also have a reduced outward displacement or a paradoxical inward displacement of the ventral abdominal wall during inspiration. This has led to the suggestion that they may have less use of the diaphragm, possibly secondary to chronic muscle fatigue. To assess the effect of COPD on the neural drive to the diaphragm, we inserted needle electrodes into the costal part of the right hemidiaphragm in eight patients with severe disease (mean [+/- SD] FEV1: 0.82 [+/- 0.27] L) and six control subjects of similar age, and measured the discharge frequencies of single motor units during resting breathing. A total of 115 diaphragmatic motor units were recorded in the control subjects and 122 in the patients. All motor units discharged rhythmically in phase with inspiration. However, whereas 95% of the units in the control subjects had a peak discharge frequency between 7 and 14 Hz, 79% of the units in the COPD patients had a peak discharge frequency greater than 15 Hz. As a result, the discharge frequency of all units averaged 10.5 [+/- 2.4] Hz in the control subjects, but 17.9 [+/- 4.3] Hz in the patients (p < 0.001). These observations indicate that patients with severe COPD have an increased neural drive not only to the rib cage inspiratory muscles, but also to the diaphragm. Consequently, the reduced inspiratory expansion of the abdomen in severe COPD results from mechanical factors alone.

To measure voluntary activation of human elbow flexor muscles during maximal concentric contractions, the twitch interpolation method was modified to enable detection of torque increments evoked by single stimuli during contractions of up to 300 deg s−1. Subjects flexed the elbow to rotate a loaded beam ‘as fast as possible’ (load typically 23–58 N m) from 70 deg below to 70 deg above the horizontal. Electrical stimuli were delivered to biceps brachii when the beam passed through the horizontal. Voluntary activation was estimated from the amplitude of the interpolated twitch, which was expressed as a percentage of the twitch produced by relaxed muscles shortening at the same velocity. In eleven subjects, the level of voluntary activation during repeated maximal concentric contractions (median 99.4 %) did not differ significantly from that during maximal isometric contractions (98.0 %). Voluntary activation during maximal contractions did not depend on shortening velocity and was the same when tested at two angles 30 deg apart. To induce fatigue, five subjects repeatedly lifted and lowered a heavy load at about 30 deg s−1, and continued for ten to twelve contractions after they needed assistance to continue lifting. All maintained the capacity to attain maximal levels of activation. It is concluded that voluntary drive to elbow flexor muscles during maximal concentric contractions is usually maximal or near‐maximal, and that this level of drive can be maintained during development of peripheral fatigue.

To determine whether patients with chronic obstructive pulmonary disease (COPD) contract the inspiratory muscles of the rib cage more strongly than do healthy subjects, we recorded the discharge frequencies of single motor units in the scalene and second parasternal intercostal muscles of seven patients with stable COPD (FEV1 = 33 +/- 13% predicted, mean +/- SD) and seven control subjects. Recordings were made with insulated monopolar electrodes during resting breathing, and single motor-unit discharges were identified with a customized method based on "template" matching. A total of 211 motor units were recorded in the control subjects and 260 in the patients. The inspiratory discharge frequencies were greater in the COPD patients than in the control subjects for both the parasternal (13.4 versus 10.1 Hz, p < 0.05) and scalene (11.4 versus 8.5 Hz, p < 0.02) muscles. Recording sites at which no motor units were recruited were more common in the control subjects than in the patients (p < 0.001). The sternomastoid muscle was silent in both subject groups. Therefore, effective central neural drive is increased to both the scalene and parasternal intercostal muscles but not to the sternomastoid muscle in patients with COPD.

In 2001 the University of New South Wales Faculty of Medicine embarked on designing a curriculum-management system to support the development and delivery of its new, fully integrated, outcome-based, six-year undergraduate medicine program. The Web-enabled curriculum-management system it developed is known as eMed, and it comprises a suite of integrated tools used for managing graduate outcomes, content, activities, and assessment in the new program. The six main tools are a curriculum map, timetable, student portfolio, peer feedback tool, assessment tracking, and results tools. The eMed functions were determined by organizational and curricular needs, and a business management perspective guided its development. The eMed project was developed by a multidisciplinary team, and its successful development was achieved mostly by methodically identifying the scope of each tool and the business processes it supports. Evaluation results indicated a high level of user acceptance and approval. The eMed system is a simple yet effective educational technology system that allows users to evaluate and improve the curriculum in real time. As a second-generation curriculum-management system, eMed is much more than an educational administration system; it is a knowledge network system used by staff and students to transform data and information into knowledge and action. The integration of learning and assessment activities data in the one system gives a depth of curriculum information that is unusual and that allows for data-based decision making. Technologically, eMed helps to keep the medicine program up to date. Organizationally, it strengthens the school's data-driven decision-making process and knowledge network culture.