Evaluating the effectiveness and outcomes associated with direct peritoneal resuscitation in damage control surgery patients with and without hemorrhagic shock.

INTRODUCTION: This narrative review aims to evaluate the efficacy of adjunct direct peritoneal resuscitation (DPR) in the treatment of adult damage control surgery (DCS) patients both with and without hemorrhagic shock, and its impact on associated outcomes. METHODS: PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane were searched for relevant articles published through April 13th, 2023. Studies assessing the utilization of DPR in adult DCS patients were included. Outcomes included time to abdominal closure, intra-abdominal complications, in-hospital mortality, and ICU length of stay (ICU LOS). RESULTS: Five studies evaluating 437 patients were included. In patients with hemorrhagic shock, DPR was associated with reduced time to abdominal closure (DPR 4.1 days, control 5.9 days, p = 0.002), intra-abdominal complications including abscess formation (DPR 27 %, control 47 %, p = 0.04), and ICU LOS (DPR 8 days, control 11 days, p = 0.004). Findings in patients without hemorrhagic shock were conflicting. Closure times were decreased in one study (DPR 5.9 days, control 7.7 days, p < 0.02) and increased in another study (DPR 3.5 days, control 2.5 days, p = 0.02), intra-abdominal complications were decreased in one study (DPR 27 %, control 47 %, p = 0.04) and similar in another, and ICU LOS was decreased in one study (DPR 17 days, control 24 days, p < 0.002) and increased in another (DPR 13 days, control 11.4 days, p = 0.807). CONCLUSION: In patients with hemorrhagic shock, adjunct DPR is associated with reduced time to abdominal closure, intra-abdominal complications such as abscesses, fistula, bleeding, anastomotic leak, and ICU LOS. Utilization of DPR in patients without hemorrhagic shock showed promising but inconsistent findings.

Superior Photophysical and Photosensitizing Properties of Nanoaggregates of Weakly Emissive Dyes for Use in Bioimaging and Photodynamic Therapy.

The development of luminescent dyes based on 1,1,4,4-tetracyanobuta-1,3-dienes (TCBDs) is an active research area, and a quantum yield (ΦF) of 7.8% has been achieved so far in cyclohexane by appending a fluorophore. Our novel method radically refines weakly emissive 2,3-disubstituted TCBD (phenyl-TCBD 1) (ΦF = 2.3% in CH3CN) into a water-soluble, biocompatible nanoformulation as highly emissive aggregates 1NPs ⊂ PF-127 with ΦF = 7.9% in H2O and without fluorophore conjugation. Characterization of 1NPs ⊂ PF-127 was carried out using various spectroscopic techniques, and its predominant size was found to be 80-100 nm according to transmission electron microscopy and dynamic light scattering techniques. Spectroscopic studies including Fourier transform infrared spectroscopy revealed that aggregated phenyl-TCBD particles were encapsulated in a nonluminescent triblock copolymer (PF-127)-based nanomicelles with the TCBD entrapment efficiency of 77%. With increasing water fraction, the phenyl-TCBD nanoaggregates exhibited a 3-fold higher quantum yield, a greater lifetime, and a red shift (155 nm). This remarkable enhancement in red emissivity enabled them to be used as a bioprobe for bioimaging applications and in photodynamic therapy to selectively target cancer cell lines with singlet oxygen generation capability (ΦΔ = 0.25). According to the MTT assay, compared to the native molecular form (1229 nM), the aggregated 1NPs ⊂ PF-127 (13.51 nM) exhibited dose-dependent cell death when exposed to light with 91-fold increased activity. The histoarchitectures of various vital organs (liver, kidneys, heart, lungs, and spleen) were intact when tested for in vivo biocompatibility. This study has significant implications for developing nonplanar push-pull chromophore-based dyes as biosensors and with potential applications beyond bioimaging.

Assessing Effectiveness and Efficiency of Need for Trauma Intervention (NFTI) and Modified NFTI in Identifying Overtriage and Undertriage Rates and Associated Outcomes.

INTRODUCTION: Limited research has assessed the effectiveness of Need for Trauma Intervention (NFTI) and Modified NFTI (MNFTI) criteria in accurately identifying triage rates in major trauma. We aim to evaluate the predictive capability of NFTI/MNFTI in determining rates of overtriage and undertriage, as well as associated outcomes. METHODS: A literature search was conducted utilizing PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane from conception to April 13th, 2023. Studies assessing the utilization of NFTI/MNFTI in identifying over and undertriage rates were included. Additional outcomes including mortality, ICU LOS, and resource allocation were evaluated. Outcomes were compared between NFTI/MNFTI and other triage metrics. RESULTS: A total of 8 articles, including 175,650 trauma patients, were evaluated. NFTI utilization was associated with reduced overtriage rates compared to numerous tools including trauma triage matrix (TTM) and need for emergent intervention within 6 h (NEI-6) (NFTI 32.15%, TTM 44.5%, NEI-6 42.23%). Regarding undertriage, NFTI had lower rates than the secondary triage assessment tool (STAT) and TTM (NFTI 14.0%, STAT, 22.3%, TTM 14.3%) as well as Cribari Matrix Method (CMM) (NFTI .8%, CMM 7.6%, P < .0003). Additionally, the utilization of NFTI in combination with CMM yielded a significant reduction in undertriage rates compared to either tool alone (CMM/NFTI 2.7%, NFTI 4.6%, CMM 8.2%). CONCLUSION: Implementation of NFTI/MNFTI resulted in more accurately capturing over and undertriage rates. Similar trends were identified when NFTI was used in combination with CMM. When compared to other triage tools, NFTI outperformed CMM, TTM, STAT, and NEI-6 in overtriage and/or undertriage rates.

Telehealth Utilization in Trauma Care: The Effects on Emergency Department Length of Stay and Associated Outcomes.

INTRODUCTION: Since the onset of the Covid-19 Pandemic, Telehealth utilization has grown rapidly; however, little is known about its efficacy in specific areas of healthcare, including trauma care in the emergency department. We aim to evaluate telehealth utilization in the care of adult trauma patients within United States emergency departments and associated outcomes over the past decade. METHODS: PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane were searched for relevant articles published from database conception to Dec 12th, 2022. Our review includes studies that assessed the utilization of telehealth practices within a United States emergency department for the treatment of adult (age ≥ 18) trauma patients. Evaluated outcomes included emergency department length of stay, transfer rates, cost incurred to patients and telehealthimplementing hospitals, patient satisfaction, and rates of left without being seen. RESULTS: A total of 11 studies, evaluating 59,319 adult trauma patients, were included in this review. Telehealth practices resulted in comparable or reduced emergency department length of stay for trauma patients admitted to the emergency department. Costs incurred to the patient and rates of leaving without being seen were significantly reduced following telehealth implementation. There was no difference in transfer rates or patient satisfaction for telehealth practices compared to in-person treatment. CONCLUSION: Emergency department telehealth utilization significantly reduced trauma patient care-related costs, emergency department length of stay, and rates of leaving without being seen. No significant differences were found in patient transfer rates, patient satisfaction rates, or mortality rates following emergency department telehealth utilization.

A study of [2 + 2] cycloaddition-retroelectrocyclization in water: observation of substrate-driven transient-nanoreactor-induced new reactivity.

Organic solvents limit [2 + 2] cycloaddition-retroelectrocyclization (CA-RE) in biological fields. We examined the formation of 1,1,4,4-tetracyanobuta-1,3-dienes (TCBDs) through CA-RE reactions and their unusual reactivity to produce N-heterocyclic compounds when the nature of the surfactant and the concentrations were varied in the aqueous phase. An environment in which transient self-assemblies (vesicles) were induced by the substrate and surfactant molecules initiated new reactivity through H2O addition on the TCBD, generating the enol form of the intermediate, which results in the formation of the 6,6-dicyano-heteropentafulvene (amidofulvene) compound, while lamellar sheets at higher concentrations favored TCBD generation. Interestingly, the amidofulvene underwent a clean transformation to 6-membered heterocycles that resemble cardiotonic drugs (milrinone, amrinone) via keto-enol tautomerism mediated by a polar aprotic solvent, opening up a new avenue for drug discovery. Unlike organic-solvent-mediated CA-RE reactions, the present nanoreactor-mediated approach enabled the selective production of TCBDs as well as new heterocycles using H2O as a green solvent. In addition to the widely explored organic electronics/materials, we believe that this study will help to overcome the long-standing limitation of CA-RE reaction applicability in biological fields.

New Water-Soluble Magnetic Field-Induced Drug Delivery System Obtained Via Preferential Molecular Marriage over Narcissistic Self-Sorting.

Nanomaterials that respond to stimuli are of considerable interest for drug delivery applications. Drug delivery has been a leading challenge when it comes to the externally triggered controlled release of hydrophobic drugs. The present paper describes a unique arrangement of polymers in a competitive environment derived from the dynamic self-sorting behavior of the hydrophobic chains of amphiphilic mPEG-PLLA and poly-l-lactic acid (PLLA)-coated iron oxide nanoparticles IONP@PLLA to achieve a core-shell structure in which the hydrophobic PLLA part acts as a dense core and poly(ethylene glycol) (PEG) as an uncrowded shell. By using irreversible covalent interactions created by hydrophobic polymer-functionalized IONPs, it was possible to selectively form socially self-sorted nanocarriers (SS-NCs) with a higher hydrophobic core than the hydrophilic shell over narcissistic self-sorted nanocarriers (NS-NCs), that is, homo-micelles of amphiphilic polymers. The higher hydrophobic core of SS-NCs is indeed helpful in achieving higher drug [doxorubicin (DOX)] loading and encapsulation efficiencies of around 17 and 90%, respectively, over 10.3 and 65.6% for NS-NCs. Furthermore, due to the presence of IONPs and the densely packed hydrophobic compartments, the controlled release of DOX was facilitated by direct magnetism and temperature stimulation when an alternating magnetic field (AMF) was applied. An appreciably higher rate of drug release (∼50%) than that without AMF (∼18%) was achieved under ambient conditions in 24 h. The present study, therefore, proposes a new drug delivery system that exceeds homo-micelles and adds an extra feature of manipulating drug release through magnetism and temperature, that is, hyperthermia.

Nanotechnology-Assisted, Single-Chromophore-Based White-Light-Emitting Organic Materials with Bioimaging Properties.

White-light-emitting (WLE) organic materials, especially small molecules comprising a single chromophoric unit, have received much attention due to their tremendous use in modern-day electronic devices and biomaterials. They can increase the efficiency and lifetime of devices compared to the currently used combination approach. Herein, we explored a small symmetric push-pull organic molecule Hexyl-TCBD with a single 1,1,4,4-tetracyanobuta-1,3-diene (TCBD) chromophoric unit containing urea as a key functional group on an acceptor-donor∼donor-acceptor (A-D∼D-A) backbone for its ability to show white-light emission in solution as well as in the solid state. The luminescence was absent in the solid state due to the H-bonding- and π-stacking-driven quenching processes, while emission behavior in solution was tunable with variable CIE chromaticity index values via hydrogen (H)-bonding-governed disaggregation phenomena. Translation of WLE from the Hexyl-TCBD solution to a solid state was demonstrated by utilizing nonemissive polystyrene (80 wt % with respect to the chromophore) as the matrix to obtain WLE nanofibers (made by the electrospun technique) via segregating the molecules. The optical microscopy study validated the WLE nanofibers. The presence of multicolor photoluminescence, including white light, could be fine-tuned through various excitation wavelengths, solvent polarities, and polystyrene matrices. Furthermore, the detailed photophysical studies, including lifetime measurements, indicated that the inherent intramolecular charge transfer (ICT) bands of Hexyl-TCBD exhibit better ICT state stabilization by space charge distribution through the modulation of H-bonding between urea groups. Finally, a cytotoxicity study was performed for Hexyl-TCBD on normal and cancer cell lines using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay to explore bioimaging applications in biosystems. MTT results revealed significant toxicity toward cancer cells, whereas normal cells exhibited good biocompatibility.

Signaling Integration of Hydrogen Sulfide and Iron on Cellular Functions.

Significance: Hydrogen sulfide (H2S) is an endogenous signaling molecule, regulating numerous physiological functions from vasorelaxation to neuromodulation. Iron is a well-known bioactive metal ion, being the central component of hemoglobin for oxygen transportation and participating in biomolecule degradation, redox balance, and enzymatic actions. The interplay between H2S and iron metabolisms and functions impacts significantly on the fate and wellness of different types of cells. Recent Advances: Iron level in vivo affects the production of H2S via nonenzymatic reactions. On the contrary, H2S quenches excessive iron inside the cells and regulates the redox status of iron. Critical Issues: Abnormal metabolisms of both iron and H2S are associated with various conditions and diseases such as iron overload, anemia, oxidative stress, and cardiovascular and neurodegenerative diseases. The molecular mechanisms for the interactions between H2S and iron are unsettled yet. Here we review signaling links of the production, metabolism, and their respective and integrative functions of H2S and iron in normalcy and diseases. Future Directions: Physiological and pathophysiological importance of H2S and iron as well as their therapeutic applications should be evaluated jointly, not separately. Future investigation should expand from iron-rich cells and tissues to the others, in which H2S and iron interaction has not received due attention. Antioxid. Redox Signal. 36, 275-293.

Reticular-Chemistry-Inspired Supramolecule Design as a Tool to Achieve Efficient Photocatalysts for CO2 Reduction.

Photocatalytic CO2 reduction into C1 products is one of the most trending research subjects of current times as sustainable energy generation is the utmost need of the hour. In this review, we have tried to comprehensively summarize the potential of supramolecule-based photocatalysts for CO2 reduction into C1 compounds. At the outset, we have thrown light on the inert nature of gaseous CO2 and the various challenges researchers are facing in its reduction. The evolution of photocatalysts used for CO2 reduction, from heterogeneous catalysis to supramolecule-based molecular catalysis, and subsequent semiconductor-supramolecule hybrid catalysis has been thoroughly discussed. Since CO2 is thermodynamically a very stable molecule, a huge reduction potential is required to undergo its one- or multielectron reduction. For this reason, various supramolecule photocatalysts were designed involving a photosensitizer unit and a catalyst unit connected by a linker. Later on, solid semiconductor support was also introduced in this supramolecule system to achieve enhanced durability, structural compactness, enhanced charge mobility, and extra overpotential for CO2 reduction. Reticular chemistry is seen to play a pivotal role as it allows bringing all of the positive features together from various components of this hybrid semiconductor-supramolecule photocatalyst system. Thus, here in this review, we have discussed the selection and role of various components, viz. the photosensitizer component, the catalyst component, the linker, the semiconductor support, the anchoring ligands, and the peripheral ligands for the design of highly performing CO2 reduction photocatalysts. The selection and role of various sacrificial electron donors have also been highlighted. This review is aimed to help researchers reach an understanding that may translate into the development of excellent CO2 reduction photocatalysts that are operational under visible light and possess superior activity, efficiency, and selectivity.

Synergistic Effects of Carbon Dots and Palladium Nanoparticles Enhance the Sonocatalytic Performance for Rhodamine B Degradation in the Absence of Light.

Carbon dot (CD) and palladium nanoparticle (Pd NP) composites are semiconducting materials having tremendous applications in catalysis with suitable band gaps. However, their combination with a suitable polymer matrix in sonophotocatalysis has not been explored. Herein, we have synthesized and characterized a new nanohybrid catalyst from a polyamide cross-linked CD-polymer and subsequent deposition of Pd NPs. A sonocatalytic activity of 99% rhodamine B dye degradation was achieved in mere 5 min in the dark. A model catalyst replacing CDs with benzene and other control studies revealed that the synergistic effects of CDs and Pd NPs enhance the sonocatalytic activity of the nanohybrid catalyst. Interestingly, visible light did not influence the activity significantly. Mechanistic investigations suggest that generation of reactive oxygen species on the surface of the CD-polymer initiated by ultrasound, which is further facilitated by Pd NPs, is the key for remarkable catalytic activity (a rate constant of 0.99 min-1). Recyclable heterogeneous catalysts under ambient conditions are promising for exploring sono-assisted dark catalysis for several avenues.

H2S-stimulated bioenergetics in chicken erythrocytes and the underlying mechanism.

The production of H2S and its effect on bioenergetics in mammalian cells may be evolutionarily preserved. Erythrocytes of birds, but not those of mammals, have a nucleus and mitochondria. In the present study, we report the endogenous production of H2S in chicken erythrocytes, which was mainly catalyzed by 3-mercaptopyruvate sulfur transferase (MST). ATP content of erythrocytes was increased by MST-generated endogenous H2S under normoxic, but not hypoxic, conditions. NaHS, a H2S salt, increased ATP content under normoxic, but not hypoxic, conditions. ATP contents in the absence or presence of NaHS were eliminated by different inhibitors for mitochondrial electron transport chain in chicken erythrocytes. Succinate and glutamine, but not glucose, increased ATP content. NaHS treatment similarly increased ATP content in the presence of glucose, glutamine, or succinate, respectively. Furthermore, the expression and activity of sulfide:quinone oxidoreductase were enhanced by NaHS. The structural integrity of chicken erythrocytes was largely maintained during 2-wk NaHS treatment in vitro, whereas most of the erythrocytes without NaHS treatment were lysed. In conclusion, H2S may regulate cellular bioenergetics as well as cell survival of chicken erythrocytes, in which the functionality of the electron transport chain is involved. H2S may have different regulatory roles and mechanisms in bioenergetics of mammalian and bird cells.

Tuning of cross-Glaser products mediated by substrate-catalyst polymeric backbone interactions.

Tuning of cross-Glaser products using different polymeric backbones supported by copper oxide nano-catalysts has been demonstrated by tweaking the substrate-catalyst interactions under greener conditions. Further, highly reactive magnetically separable and recyclable catalyst with scalability is demonstrated.

Technical and tactical performance indicators discriminating winning and losing team in elite Asian beach soccer tournament.

The present study aims to identify the essential technical and tactical performance indicators that could differentiate winning and losing performance in the Asian elite beach soccer competition. A set of 20 technical and tactical performance indicators namely; shot back-third, shot mid-third, shot front-third, pass back-third, pass mid-third, pass front-third, shot in box, shot outbox, chances created, interception, turnover, goals scored 1st period, goals scored 2nd period, goals scored 3rd period, goals scored extra time, tackling, fouls committed, complete save, incomplete save and passing error were observed during the beach soccer Asian Football Confederation tournament 2017 held in Malaysia. A total of 23 matches from 12 teams were notated using StatWatch application in real-time. Discriminant analysis (DA) of standard, backward as well stepwise modes were used to develop a model for the winning (WT) and losing team (LT) whilst Mann-Whitney U test was utilized to ascertain the differences between the WT and LT with respect to the performance indicators evaluated. The standard backward, forward and stepwise discriminates the WT and the LT with an excellent accuracy of 95.65%, 91.30% and 89.13%, respectively. The standard DA model discriminated the teams from seven performance indicators whilst both the backward and forward stepwise identified two performance indicators. The Mann-Whitney U test analysis indicated that the WT is statistically significant from the LT based on the performance indicators determined from the standard mode model of the DA. It was demonstrated that seven performance indicators namely; shot front-third, pass front-third, chances created, goals scores at the 1st period, goals scored at the 2nd period, goals scored at 3rd period were directly linked to a successful performance whilst the incomplete save by the keeper attribute towards the poor performance of the team. The present finding could serve useful to the coaches as well as performance analysts as a measure of profiling successful performance and enables team improvement with respect to the associated performance indicators.

Designing of Push-Pull Chromophores with Tunable Electronic and Luminescent Properties Using Urea as the Electron Donor.

Urea-functionalized 4-ethynylbenzenes undergo facile formal [2 + 2] cycloaddition followed by retroelectrocyclization upon reaction with tetracyanoethylene, yielding 1,1,4,4-tetracyanobuta-1,3-dienes-based push-pull chromophores. Unlike the N,N'-dialkylamino group, urea functionalization provides easy access to further functionalization on these chromophores. The resulting chromophores exhibit unexpected white light emissions apart from various inherent properties like intramolecular charge-transfer band and redox behavior.

Endothelial function after high-sugar-food ingestion improves with endurance exercise performed on the previous day.

BACKGROUND: Endothelial function deteriorates after glucose ingestion. This may be attributed to hyperglycemia-induced oxidative stress. Acute endurance exercise might improve postprandial endothelial function by enhancing glucoregulation and reducing postprandial hyperglycemia. OBJECTIVE: The objective was to determine whether endurance exercise performed 17 h before high-sugar-food ingestion attenuates postprandial impairment in endothelial function. DESIGN: Healthy men and women (n = 13; age: 48 +/- 17 y) were studied on 2 occasions: after > or = 48 h with no exercise and 17 h after a 60-min bout of endurance exercise. During each trial, brachial artery flow mediated dilation (FMD) was used to assess endothelial function before and after the ingestion of a candy bar and soft drink. Glucose, insulin, and thiobarbituric acid-reactive substances (TBARS), a marker of oxidative stress, were measured in blood obtained during each FMD measurement. The insulin sensitivity index was calculated from the glucose and insulin data. RESULTS: FMD decreased significantly after food ingestion in both trials. However, prior exercise shifted the entire FMD curve upward (main treatment effect: P = 0.0002), which resulted in a greater area under the curve for FMD (774 +/- 122%.min) than did no exercise (607 +/- 122%.min) (P = 0.01). Prior exercise shifted the glucose and insulin curves downward (main treatment effects: P = 0.05 and P = 0.0007, respectively) and resulted in a significantly greater insulin sensitivity index (10.8 +/- 0.7) than did no exercise (9.2 +/- 0.7) (P = 0.01). TBARS did not differ significantly between trials. CONCLUSION: Postprandial endothelial function was improved by endurance exercise performed approximately 17 h earlier. This effect was accompanied by exercise-induced improvements in insulin action and reductions in glycemia, but did not correspond with reductions in oxidative stress, as assessed by TBARS.

Comparison of methods for assessing abdominal adipose tissue from magnetic resonance images.

OBJECTIVE: To compare the inter-rater and intra-rater reliability and analysis time of two methods for quantifying visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volumes from magnetic resonance (MR) images. RESEARCH METHODS AND PROCEDURES: Ten subjects (BMI, 27.0 +/- 2.1 kg/m(2); 56 years of age +/- 4 years) underwent MR imaging of the abdomen. Ten transverse T1-weighted images were selected from each scan and analyzed using two software packages that differ in principle. The first method, ANALYZE version 5.0, represents the manual threshold method, and the second, HIPPO version 1.3, is based on the fuzzy clustering approach. Inter-rater reliability for each method was assessed by comparing the intra-class correlation coefficients (ICCs) for VAT and SAT results from two evaluators, and intra-rater reliability for each method was assessed by comparing ICCs for VAT and SAT analyses performed 1 week apart by the same evaluator. The total time for analysis also was compared between methods. RESULTS: The inter-rater reliability for VAT was greater with HIPPO than with ANALYZE (ICC = 0.996 vs. 0.828), whereas inter-rater reliability for SAT did not differ between methods (ICC = 0.975 and 0.987). The intra-rater reliability was equally high with HIPPO and ANALYZE for both VAT (ICC = 0.998 vs. 0.992) and SAT (ICC = 0.996 vs. 0.992). HIPPO required less than one-half as much analysis time as ANALYZE (15.9 +/- 4.4 vs. 36.5 +/- 8.2 minutes, p < 0.0001). DISCUSSION: HIPPO software appears advantageous for the quantification of VAT from multislice MR images because inter-rater results are more reliable, and it is more time-efficient than less automated methods.

One year of caloric restriction in humans: feasibility and effects on body composition and abdominal adipose tissue.

BACKGROUND: Caloric restriction (CR) increases maximal life span in short-lived organisms, and its effects are being explored in nonhuman primates. The objectives of this study were to determine the feasibility of prolonged CR in nonobese adults and to compare the effects of CR- and exercise-induced weight loss on body composition and abdominal adiposity. METHODS: A randomized, controlled trial was conducted with 48 healthy, nonobese women and men, aged 57 +/- 1 (mean +/- standard error [SE]) years, with body mass index 27.3 +/- 0.3 kg/m2. Participants were randomly assigned to a 20% calorically-restricted diet (CR, n = 19), exercise designed to produce a similar energy deficit (EX, n = 19), or a healthy lifestyle control group (HL, n = 10) for 1 year. Assessments included weight, body composition by dual-energy x-ray absorptiometry, abdominal adipose tissue by magnetic resonance imaging, and energy intake by doubly labeled water. RESULTS: The average level of CR achieved by the CR group was 11.5 +/- 2.1%, and the EX group completed 59 +/- 6.7% of their prescribed exercise. Weight changes were greater (p